AIDS Acquired Immunodeficiency Syndrome - Assignment Example

 AIDS (Acquired immunodeficiency syndrome) Introduction HIV is the leading cause of deaths in the world. Unites States has also suffered and still fighting against the increasing rate of prevalence of the infection. This research describes the background of HIV in the US followed by its distribution (in the US and in the world), mortality and morbidity rates, distribution and determinants of disease and its treatment and prevention in the community. The research also presents a study design stating two hypotheses and discussing the external and internal validity of the proposed research. Problem definition AIDS (Acquired immunodeficiency syndrome) is a life threatening chronic disease which is caused by the human immunodeficiency virus (HIV). This virus destructs the immune system of the body, thus making it incapable to combat against viruses, bacteria and fungi which cause infection in the body. It greatly weakens the body defense system which makes the person susceptible to carcinomas and infections like pneumonia and meningitis (Weeks & Alcamo, 2010). There are four major routes for the transmission of the virus, including sex without using protection, breast milk, contaminated needles and transfer from mother to baby during labor. The virus has reported to kill more than 25 million people from 1981 to 2006. Around 0.65 of the world population has been infected with the virus (Hall, Hall, & Cockerell, 2011). The common symptoms of AIDS include fever, rashes, head ache, sore throat, fatigue, muscle pain, joints pain, memory loss, persistent diarrhea, vision loss and swollen glands (Lashley & Durham, 2009). Due to increasing rate of AIDS patients every year the disease is becoming progressively significant in the US. Although therapy and diagnostic measures are there, but the HIV infection is still prevailing among US population. The current health scenario of AIDS patients in the US demands serious steps to be taken for controlling the growing rate of HIV. The HIV history began in the US in 1981, US was the first country to officially report the disease cases. Presently the origin of AIDS in considered to be linked with Africa. US brought public awareness about the disease for the first time, which recognized the disease as the most controversial, politicized and feared disease in the medical history (Stolley & Glass, 2009). The disease was discovered among few gay men in the US. Initially the symptoms of the disease were interpreted as cancer or pneumonia. The US Centers for Disease Control and Prevention (CDC) published the first report on June 5 1981 which declared that the five gay men were infected with (PCP) Pneumocystis Pneumonia Carinii, cytomegalovirus, and disseminated Candida infections. After a month the New York Times reported 41 cases of Kaposi’s sarcoma among homosexual men. By the end of 1981 every week 5 to 6 new cases were being recorded in the US. In the following year the disease was named as GRID 5 (gay-related immune deficiency or gay cancer. By June 1982, 355 cases were recorded with same infection and this time it also included men and women victims (CDC, 2013). Extent of the health condition In United States AIDS has been the major cause of deaths in the US in adults during 1980s. Since 1980s to 1990s very few treatment options were available therefore; the mortality rate was much higher. The health condition of AIDS patients began to improve in 1996, after the introduction of multiple antiretroviral drugs regimen which act at various stages of the disease cycle. The combined regimen for AIDS is known as HAART. The introduction of HAART brought a serious decline in the morbidity and mortality rates in the US. The mortality rate of HIV was 27.3 among the 100,000 population during 1995-1997 which reduced to 9.6 in 1997. After 1997 the mortality rate slowed down in all races, ages and gender groups (National Center for Health Statistics, 2014). According to CDC, the numbers of new cases of HIV reported in 2011 were 49,273. The mortality rate of HIV till 2011 was 2.5 in 100,000 populations and the number of deaths were 7683 (National Center for Health Statistics, 2014). Worldwide Around 35.3 million people were living with AIDS by the year 2012. Since 1981 till 2012 more than 25 million people have died because of AIDS. The HIV cases have been reported from different parts of the world in which most of the cases were originated from Sub-Saharan Africa. Advancement in treatment and available therapy has greatly decreased the overall number of AIDS patients. In poor countries the individuals receiving therapy for AIDS has been increased to 10 times estimating 4 million people by 2008 (AIDS.gov, 2012). It is reported that by 2008, 4.7 million people were having AIDS, in Europe and Central Asia 1.5 million people were living with AIDS, whereas in Latin America 2 million people were reported to be living with HIV. Morbidity: Overall in 2012, 35.3 million people were reported to be living with HIV. Around 2.3 million people were new cases of HIV in 2012. Since 2001, 25 countries showed a significant drop more than 50% in HIV infection. In children the new infections were 43% lower than in 2003. Mortality: The mortality rate of AIDS was reduced to 24% from 2011 (1.7 million deaths) to 1.6 million deaths in 2012 (AIDS.gov, 2012). Morbidity United States World 1.8 million (2007) 49,273 (2011) Out of 100,000 population 33.2 million (2007) 35.3 million (2012) Mortality 650,000 (2007) 7683 (2011) Out of 100,000 population 2.1 million (2007) 1.6 million (2012) Table 1 WHO Sources: (WHO, 2014), (WHO, 2007) The mortality rate in 1995-1996 was 27.3 which was reduced to 9.6 in 1997 which further decreased to 2.5 in 2011. The mortality rate of HIV/AIDS in the world from 1995-1998 was 33 which decreased significantly to 6.2 in 2000. Thu,s it can be said that the overall mortality rate decreased markedly in last 10 years where as in the world the percentage is still higher which might be due to less access to treatment and screening tests in African countries where the AIDS/HIV prevalence is highest (National Center for Health Statistics, 2014). Figure 1 Worldwide distribution of HIV/AIDS. Source: (AIDS.gov, 2012) Disease Description Person According to CDC estimation, more than 1.1 million individuals of age 13 and above with AIDS were living in the US. Among them, 15.8% were unaware of their infection. The incidence of new infections was found to be 50,000 per year. For last 10 years the number of people living with HIV has increased, whereas the relative number of infections per year is stable (AIDS.gov, 2014). The major risk of HIV was found to be associated with homosexual relationship among men. In all races and ethnic groups there is a considerable increase in reported AIDS cases among homosexual men (Hall, Hall, & Cockerell, 2011). In 2010, the reported cases were 29,800 which is a 12% increase from 2008 in which 26,700 were recorded. The overall percentage of the recorded AIDS cases in homosexual men was 52% in 2009 which rose to 78% in 2010. The group was further divided into white and black homosexual men. Among them, in 2010, 11,200 white homosexual men were recorded with new HIV infections while 10,600 in black homosexual men. The targeted age group of HIV infections in homosexual men was 13-24 years. Young black men reported 55% cases, while young white men reported 45% (CDC, 2013). Based on race the African Americans showed the maximum number of reported HIV cases. Around 44% of AIDS cases are found to be associated with black Americans. The numbers of reported deaths in 2010 among black Americans from HIV were 7,678. If the same epidemics continued, 1 out of 16 black men and 1 out of 32 black women will be infected with HIV. The other major subgroup affected by HIV in the US is the Hispanics/ Latinos. 21% of the new HIV infection cases were reported by this group. The incidence of HIV infection was 2.9 times higher in Hispanics as compared to white Americans. The recorded number of deaths in Hispanics in 2010 due to HIV was 2.370. Figure 2 Most Affected groups from HIV in the US Source: (CDC, 2013) Time According to National Vital Statistical Report (2013), HIV is not among 15 leading death causes in the US since 1997, however, it is still a major health issue in particular age groups. The disease was first reported in 1981 and reached the highest mortality rate in 1995. The recorded number of cases of HIV rose from 1987 to 1994. Later, a significant decrease in rate of incidence of HIV infections was observed during 1995 to 1998 with the percentage of 33% and from 1999 to 2000 6.2% per year. In 2010 AIDS was among the 15 leading cause of death in different age groups (Murphy, Xu, & Kochanek, 2012). Place Since the emergence of HIV, around 75 million people are recorded to be infected from the virus causing the death of 36 million people. Every region and country has different epidemics of HIV; however, the Sub-Saharan Africa region has reported the maximum number of cases of HIV constituting 71% of the overall reported cases. The disease prevalence is much higher in in this region where 1 out of 20 adults is reported to have HIV infection (WHO, 2014). According to WHO, the percentage of HIV prevalence in the Western Pacific is 0.1% (lowest), Mediterranean region, 0.2%, South East Asia, 0.3%, Europe 0.4%, America 0.5% and Africa 4.5% (highest). The overall prevalence percentage of AIDS in the world is 0.8%. Figure 3 Disease prevalence in different parts of the world (2012) Source: (WHO, 2012) Disease Distribution and Determinants HIV is one of the most challenging pandemics in global public health. According to CDC in 2010, 5 million of the young population age 15-24 was living with HIV constituting 41% of the total affected population. Approximately 890,000 young people acquire HIV each year means 2500 acquire HIV each day. The percentage is daunting enough to attract the concentration of researchers and health professionals. Distribution Among youth, the distribution is also somehow similar to that of general disease distribution in other age groups. By the end of 2010, 95% of the infections are found in under developing countries, mainly the Sub Saharan region. It has been found that in young generation women are more vulnerable to HIV rather than men. This condition is vice versa in case of adults. Young women acquire 60% of the HIV infection. Further subdivisions of young population depending on more risk for HIV is young drug addicts using injections, bisexual men and sex workers (National Center for Health Statistics, 2014). In 2010, 3.8 million youth were living with HIV in the Sub Saharan region due to unsafe sex. In the Middle East and North Africa 94,000 were reported with HIV. The infected youth population in this region was 36,000 in 2001 which increased to double that is 75,000 in 2009. Latin America and Caribbean region recorded 250,000 young cases of HIV. The Caribbean region has the highest prevalence rate of HIV after Sub Saharan region. In Central and Eastern Europe and Central Asia the young population living with HIV is 81,000. Where Russia and Ukraine acquired 95% of the infections because of needle injections. South Asia and Asia Pacific recorded 500,000 cases in youth. India, Thailand and Nepal have shown a 25% decrease in prevalence whereas Bangladesh reported a 25 % increase in cases. The industrialized countries (US, Canada, Europe) have reported 150,000 youths living with HIV (WHO, 2014) Young population in the United States accounted for 26% of infected cases counting 12,200 people in 2010 (Amfar, 2010). Among them bisexual and gay men accounted for 72% cases. The black youth shared 57% (7000) of the infected youth population, whereas Hispanics/Latinos accounted for 20% (2,390) and white Americans 20% (2,380) respectively (CDC, 2014). Determinants Intrinsic Determinants The intrinsic determinant of AIDS is the human immunodeficiency virus (HIV) which is the living agent responsible for causing the disease (FAO, 2014). Extrinsic Determinants Extrinsic determinants could be social and environmental determinants having significant impact on the disease condition. The environmental determinants having considerable impact on AIDS include weather, environment, policies, pollution, etc. (Nichols, Tchounwou, Mena, & Sarpong, 2009). As in case of AIDS, the immune system is compromised, this increases the susceptibility of a person to catch diseases. The environmental determinants increase the chances of infections in unfavorable and unhealthy environment; therefore, there will be more chances for the exposure and invasion of harmful bacteria, viruses and spores. The patients of AIDS do not have strong immune system for combating against these microbes, therefore the condition become very serious. Hence; for prevention and management of AIDS, controlling the environmental determinants is very important. Socio-economic Determinants The health outcomes of a population are mainly dependent upon the complicated social and economic structure, which constitute the social determinants of health (McCurtis & Dudek, 2012). Research Studies Research studies by Kethleen (2010), Hazel and Kevin (2010) have explained the impact of extrinsic determinants on HIV/AIDS. The common social determinants which are important for controlling the health outcomes and HIV/AIDS epidemics include childhood development, education, discrimination, stigma, the resilience of the gay community and job security, access to health services, sexual behavior, source of income, social interaction and response of society towards infected individuals (Hazel & Kevin, 2010). These determinants identify the context of vulnerability that can either promote the risk exposure to HIV or hinders in taking preventive measures (Kethleen, 2010). Mignone (2007) has identified other determinants also having a significant impact of HIV spread and control these include gender inequality, family and community health, provision of facilities, access to resources, political freedom and institutional development (Mignone, 2007). Based on the research studies assessing the impact of extrinsic and intrinsic determinants on HIV/AIDS, following hypothesis is derived: Hypothesis: Socio-economic determinants have contributed in increasing of HIV epidemics in youth in last 10 years. Data Interpretation Issues and Knowledge Gaps Knowledge gaps During the course of research, I observed the knowledge gap in disease prevalence, cause, symptoms, diagnosis and treatment of AIDS. This research helped me in covering my knowledge gaps and explore the topic in detail. Data interpretation issues In the current literature review few data interpretation issues occurred. No research publication, journal article or report presented current values of disease epidemics. Data up to 2012 was available which was used for analysis. In order to analyze the current status of the disease, including disease prevalence, morbidity, mortality rates, number of infections and reported cases most recent data of 2013 and 2014 was required. The unavailability of recent updates on different aspects of the disease offered hindrance in data interpretation. Due to limited research material found on determinants of HIV, data interpretation became difficult. Only studies covering social determinants were available which were covered as a part of the research, but assessing the extrinsic and intrinsic determinants became troublesome because of the lack of pertinent data. It was also found that most of the information, particularly the statistics of the disease were repeated. It caused a problem as no other data were available for comparing the two sources of information. Therefore; the available information was being used considering it as credible because of the authenticity of the source that is CDC. Experimental Design Hypothesis H1: The prevalence of HIV in youth, age (15-24) is maximum among bisexual and gay boys in the US. OR H2: Socio-economic determinants have contributed in increasing of HIV epidemics in youth in last 10 years. Introduction HIV is one of the leading epidemic diseases in the world. Initially the disease was limited to the adult population, but recent studies have found that the disease prevalence has greatly increased among the young population in the world. The purpose of this study is to evaluate different factors contributing in disease prevalence in youth, particularly in bisexual and gay population and assess the effectiveness of prevention programs in controlling the spread of disease. Dependent Variables Increase prevalence of HIV in young individuals, prevention programs Independent Variables Lack of sexual education, family backgrounds, ethnicity, unsafe sex, health policies. Data Collection Academic databases including Ebscohost and Cinahl and internet search options were used for gathering research information. CDC surveys on HIV/AIDS prevalence have been accessed for current statistics. Population Age: 15-24. Gender: male. 10,000 boys, 7,500 black African Americans, 1200 black Hispanics, 1300 white Hispanics and 1000, white Americans. Inclusion and Exclusion criteria: Young boys age between 15-24 being involved in men to men sex. Measuring Instruments CDC surveys on prevalence of AIDS and government policies for controlling AIDS prevalence. Methodology of Research Meta-analysis and systematic review to analyze statistical data and available literature. Limitation It has been found that the statistical data on HIV prevalence in youth in the US is only available up to 2010, which created a limitation in obtaining the most recent statistics on HIV prevalence. Internal Validity The data revealed that socioeconomic factors and bisexual relation in young population has prominently contributed in increasing the HIV prevalence. Thus, the research has internal validity. Literature review of studies and prevalence surveys by CDC have given accurate measurements of the data on AIDS which is also endorsed by other studies on HIV prevalence in US among young boys. External Validity The information obtained from researches is generalized, because the collected data represent all the young individuals involved in bisexual relationship in different parts of the US. Prevalence rate in last 10 years among the young boys from different race and ethnic groups has been studied in order to obtain a comprehensive and valid conclusion. The research has internal validity as well as external validity. Prevention and Treatment Preventive Measures Since the emergence of HIV/AIDS different countries attempted different approaches for the prevention of HIV. The purpose of these prevention programs is to control the spread of disease in communities. Most of the prevention programs focus on the most susceptible groups of individuals for developing the disease. Recent research in the US indicates that the percentage of HIV has started to rise among bisexual men, therefore; there is a great need of such programs to educate people about the preventive measures which should be considered for protection against HIV (The Basics of HIV Prevention, 2014) The first major prevention program for HIV targeted bisexual men in the US. The purpose of this program was to educate men about, having safer sex and maintaining a safer sexual relationship. These kinds of prevention programs are extremely necessary for bringing awareness in the population. As, AIDS is not a curable disease only preventive measures can be done in order to control the spread of the disease (The Basics of HIV Prevention, 2014). People at risk of developing the disease and the general population should be educated b prevention campaigns addressing the preventive measures for controlling the disease (Valerio, Beasley, & Bundy, 2008). Following preventive measures have been proven to be useful in control the disease spread. Safe sex: It is important to educate people for using protection and conducting safer sex. Use of sterile needle: People must take care of the fact that AIDS can be transferred by reusing a needle for injection purpose. It is important to break the needle once it is used and each time use a new, clean and sterile needle. Couples should be guided properly that a carrier mother can easily transfer the infection to her baby therefore, proper treatment is very necessary during the course of pregnancy. Individuals who are high risk may take medicines like emtricitabine-tenofovir (Truvada) by the advice of a medical practitioner for reducing the risk of sexually transmitted HIV (Mayo clinic, 2014). Mothers having HIV/AIDS should avoid breastfeeding and take therapy to prevent the transmission of infection to the baby. HIV screening has been made the part of routine screening for all pregnant women for early diagnosis and therapy if required. Treatment HIV/ AIDS cannot be cured, however, a combination of drugs and lifestyle changes can be used to control the virus and increase the healthy life duration. Antiretroviral drug treatment It is the major treatment for HIV, which is aimed to keep the virus level lower in the body. The treatment helps in strengthening the immune system and act against pathological changes caused by HIV in the body. The following groups of drugs are included in antiretroviral therapy. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) help in inhibiting the replication of HIV by blocking the protein required for reproduction. Examples include: nevirapine, efavirenz, etravirine, etc. Nucleoside reverse transcriptase inhibitors (NRTIs) are the fake units which, when taken up by HIV for reproduction do not produce the virus. Examples include Lamivudine, emtricitabine, tenofovir, etc. Protease inhibitors (PIs) inhibit protease which is required by HIV for multiplication. For example: fosamprenavir, Ritonavir, Darunazir, Atazanavir, etc. Fusion inhibitors: They block the invasion f HIV in the CD4 cells. For example: maraviroc and enfuvirtide. Integrase Inhibitors inhibit the enzyme integrase which is required by HIV for inserting its DNA into CD4 cells (Mayo clinic, 2014). Lifestyle changes Along with medical therapy, lifestyle changes are very important for combating HIV. Eating healthy diet is a major requirement for boosting the body defense mechanism. It is necessary to take diet composed of fruits, vegetables, whole grains and proteins. Along with taking healthy food certain food items should be avoided like partially cooked meat, oysters, raw eggs, raw seafood and unpasteurized dairy items (Mayo clinic, 2014). Vaccination Taking vaccination for common infections may also help in protecting certain diseases such as pneumonia. Exercise Performing regular exercise for keeping the immune system healthy also helps in fighting HIV. Alternative medicine Food supplements may also be taken for improving the defense system of the body and fighting against antiretroviral therapy side effects. Increase cholesterol level of anti HIV drugs can be controlled by taking fish oil supplements. Weight gain due to HIV can be controlled by taking Whey protein. It helps in increasing CD4 cell count and prevent diarrhea (Mayo clinic, 2014). Conclusion The research and literature review revealed that HIV is the most challenging epidemic disease not only in the US but in other parts of the world. Although he treatment and therapy of the virus is available, but still due to different social and economic factors the prevalence of disease is increasing among different populations. 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