Primary Health Care in the Context of HIV - Essay Example

Primary Health Care in the Context of HIV/AIDS Introduction The incidence and prevalence of HIV infection and AIDS is increasing at an alarmingrate all over the world. HIV infection has now become a pandemic affecting every country in the globe. There is not even one country that is spared of this deadly infection. Worldwide, there are about 40 million people suffering from this infection (Coovadia and Hadingham, 2005). 90% of the population suffering from HIV status is from developing countries. Worldwide, healthcare model for HIV/AIDS is shifting from hospital- oriented service to primary health center care. Research has shown that the escalation of HIV infection is not due to deficiency in effective ideas and strategies about prevention of HIV, but due to lack of political will and material resources (Makadon and Silin, 1995). Countries which are worst affected by HIV have other problems to combat which are much more severe than HIV, like poverty, famine, unemployment, political and economic instability and poor health infrastructure. There are many reasons for apparent ineffectiveness of HIV programs. These include weaknesses in the health systems of underdeveloped and poor countries, inadequate prevention strategies, lack of education and absence of vaccine (Coovadia and Hadingham, 2005). Considering these aspects, it is important to analyze which is the best modus of operation for implementing HIV-related programs. Is it the primary care physicians or the hospital-based practice? I propose that the primary health care is the best approach to target HIV and in the following paragraph I will put forth the reasons supporting this proposal. Primary health care and HIV programs According to the WHO (2009), Primary Health Care or PHC is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford." For most people from the developing and underdeveloped countries, PHC is the main source of health information, counseling, testing and treatment. Hence PHC can be considered as one of the important sources for dissipation of information of important health-related matters like HIV. Research has shown that the escalation of HIV infection is not due to deficiency in effective ideas and strategies about prevention of HIV, but due to lack of political will and material resources (Makadon and Silin, 1995). Countries which are worst affected by HIV have other problems to combat which are much more severe than HIV, like poverty, famine, unemployment, political and economic instability and poor health infrastructure. There are many reasons for apparent ineffectiveness of HIV programs. These include weaknesses in the health systems of underdeveloped and poor countries, inadequate prevention strategies, lack of education and absence of vaccine (Coovadia and Hadingham, 2005). There is a dire need for more and more increased prevention efforts and specific programs that work effectively to change the norms of the community. The programs must be able to provide meaningful information, facilitate building of new social skills and connect individual behavior to community survival concerns. Programs can be made effective when certain target groups are concentrated upon and this is possible by involving primary care physicians. Community-based health centers have a good service network and they serve people from all walks of life, including many racial and ethnic minorities and those from low-income population. According to the U.S. Department of Health and Human Services, the American College of Physicians and the U.S. Preventive Services Task Force of the American Medical Association, primary care physicians have a central role in the prevention of HIV infection (ACPIDSA, 1994). This is because, people have trust in the health information provided by the physicians and they heed the advice of their general practitioners promptly (Makadon and Silin, 1995). Most people including teenagers are willing to discuss sensitive issues like HIV/AIDS with their family physicians. Infact, research has shown that teenagers prefer to gain information from their physicians in matters such as HIV (Makadon and Silin, 1995). Because of these reasons, primary care physicians are in a better position to apply the information of the programs when it comes to certain target group like adolescents, teenagers, homosexual men and women, intravenous drug abusers, ethnic and racial minorities and incarcerated individuals. Also, more than half of the HIV antibody testing occurs in a physicians’ office, pressing more importance in their role in the prevention and management of HIV infection. The best results of counseling can happen from physicians. Physicians can counsel pregnant women about treating the fetus with zidovidine and thus can avoid vertical transmission (Makadon and Silin, 1995). According to Smith et al (1996), involvement of primary health care general practitioners in the provision of care for AIDS after appropriate training reduces the attendance of HIV cases to the hospital, the stay in the hospital, increases general practitioner consultation and improved standard of care. Fairchild et al (1990) conducted a study in Rockville, US, to examine the usefulness of community health centers in the prevention and treatment of HIV. Their study proved that community health centers are in a position to handle services related to the prevention and treatment of HIV infection especially to provide a model of care where case is managed. Considering these facts, it can be said that primary health care is the best approach for targeting HIV in the developing and underdeveloped countries where community based health care is the most frequent modus-operandi for heath issues and where funding of costly hospital-based programs is difficult because there are much more severe issues for the government to handle. Barriers to PHC-related HIV programs Barriers to health care of HIV in community based practice are knowledge, attitudes, resources and communication between the experts and the general service providers (Winn, 2007). Other barriers include narrow conceptions of role of physician, discomfort on the part of physician to discuss about sexuality and illicit drug abuse in the context of HIV, constraints of time, ambiguity of messages related to prevention of HIV (Fairchild et al, 1990). Conclusion The incidence and prevalence of HIV/AIDS is increasing at an alarming rate and despite enormous funding from the governments, many HIV programs are not successful. Most of the HIV cases are from the developing and underdeveloped countries which are taunted by other social-economic, political and health issues. Hence it is difficult for governments to fund and maintain costly hospital-based programs related to HIV. Also, most of the health-related issues are handled by primary care physicians and people in these countries have more trust and confidence in the primary care physicians and follow their advice promptly. Due to these reasons, PHC is the most appropriate approach for HIV related issues. However, there are some important barriers to these issues which need to be addressed. References American College of Physicians and Infectious Diseases Society of America. (ACPIDSA). Human immunodeficiency virus (HIV) infection. Ann Intern Med. 1994; 120:310-9. Coovadia, H.M., and Hadingham, J. (2005). HIV/AIDS: global trends, global funds and delivery bottlenecks. Globalisation and Health, 1, 13. Retrieved on 16th May, 2009 from http://www.globalizationandhealth.co m/content/1/1/13 Fairchild P, Coolidge J, Keehn A. (1990).The role of community health centers in HIV prevention and treatment services. Int Conf AIDS, 6, 462. Makadon, H.J., and Silin, J.G. (1995). Prevention of HIV Infection in Primary Care: Current Practices, Future Possibilities. Annals of Internal Medicine, 123(9), 715-719. Retrieved on 16th May, 2009 from http://www.annals.org/cgi/content/full/123/9/715 Smith, S., Robinson, J., Hollyer, J. , et al. (1996). Combining specialist and primary health care teams for HIV positive patients: retrospective and prospective studies. BMJ, 312, 416- 420. WHO. (2009). Primary health care. Retrieved on 16th May, 2009 from http://www.who.int/topics/primary_health_care/en/ Winn, S. (2007). The role of the primary health care team in the care of people with HIV and AIDS. Health and Social Care in the Community, 5(6), 408- 417. Read More