H.I.V in the Homeless in San Francisco, CA - Essay Example

H.I.V among the Homeless in San Francisco, CA Introduction Currently, those below forty years of age amongst homeless community within San Francisco are facing need for healthcare services. This demand for medication that is affordable to all making it appropriate establishment of health enterprises. Health care problem extends to a wide geographical area since it is a global phenomenon affecting many communities. Homeless communities are the most affected, especially those from the city areas. The problems that homeless community faces include lack of quality and affordable health care services, access to clean water for domestic use, proper sanitation, and good transport and communication networks. However, it is necessary to understand various factors leading to people indulging in such activities. This is necessary for the purposes of ensuring that families within San Francisco have meaningful and sustainable alternatives capable of preventing these victims from indulging in sexual and drug related activities San Francisco is located within California, USA and is one of the leading regions in HIV prevention amongst other services such as, care, and treatment from the initial stages of the epidemic within the United States. The region is recognized for provision of high quality HIV care that also involves administration of antiretroviral therapy (ART). Such healthcare services within San Francisco benefits all residents regardless of their financial abilities. San Francisco Department of Public Health (SFDPH) has considered health of the community as priority since such initiatives are crucial in reducing morbidity and mortality in those living with HIV-infections. However, methods of initiating and administering ART have changed over time. Originally, ART was recommendable only for those who were immune compromised (either a CD4 cell count under 200 cells) (Kushel et al., 2006). However, there has been increase towards CD4 count on which ART was recommendable. This was due to availability of information on the adverse effects of HIV even in the presence of moderate immunodeficiency. This was also because of record decline in ART-related toxicity and pill burden. In the year 2011, there was pronounced evidence of the effect of ART on reduced risk of sexual transmission of HIV. The publication of such information triggered debate over the risks involved in delaying therapy. However, in 2012, the U.S. Department of Health and Human Services (DHHS) reviewed its policy and advised citizens on recommendations that ART supply to all HIV-infected citizens, regardless of their CD4 count. From the time of the discovery of the disease epidemic (HIV/AIDS), there have been intensive surveillance campaigns in San Francisco. This has been done either through active or passive methods with regular evaluations. This study focuses on HIV infection commonly referred to as AIDS at ultimate stage of infection. According to Centers for Disease Control and Prevention (2012) statistics, there were over 15,000 people infected with HIV in San Francisco as at December 31, 2012. The number accounted for approximately 13% of California’s HIV living cases. There was as additional statistics of approximately 2% of persons living with HIV reported in United States. This statistics provided approximations on the rate of HIV infection in California and the United States. However, the data also revealed that amongst the persons living with HIV in San Francisco, there were more white male gays (those white men having sex with fellow men). In comparison to all persons living with HIV/AIDS, newly diagnosed cases in San Francisco for HIV victims mostly involved people of color and significant number of injection drug users (IDU). However, statistics reveal that cases of newly diagnosed HIV infections were prevalent in male, white and those practicing gay. This makes the rate of HIV prevalence to be lower amongst women as compared to men. Focusing on women alone, the rate of HIV diagnosis was found to be high amongst African Americans between 2006 and 2012 and was on increasing trend. Rates amongst other groups such as Latino women increased between years 2011and 2012, however, rate amongst white women were found to be relatively low (Centers for Disease Control and Prevention, 2012). Community Description San Francisco is considered as one of the best cities in the United States. However, the city is known for having the highest number of homeless persons amongst all United States cities. Population statistics indicates an estimate of around 15,000 people lacking homes in the city and county of San Francisco with approximately 3,000 considered chronically homeless. The spending of the county towards homeless individuals is approximated at $ 200 million on an annual basis. The amount increases due to continual rise on the number of homeless population. The natives identify homelessness as number one problem in San Francisco (National Alliance to End Homelessness, 2006). Since the disease outbreak, a total number of over twenty five thousand San Francisco residents have fallen victims of HIV/AIDS infection. The statistics as provided by University of California San Francisco Center for AIDS Prevention Studies (2005) indicates that the number as provided includes 18% of AIDS cases in California and 3% representing cases reported from the entire nation. According to statistics from CDC (2012), the number of reported deaths associated with AIDS by end 2010 stood at 19,341. Records within the same year indicated that over 15,000 San Franciscans were living with HIV/AIDS. The most vulnerable gender was found to be male with record high of approximately 92% and white approximately 63%. The highest number was recorded amongst male who had sex with fellow men (MSM) and at the same time significant number from the injecting drug users (IDU). Statistics further revealed that by end 2010, only 6% of females were living with HIV infections while 2% represented transgender. The statistics also revealed the rate of survival amongst PLWHA amongst different races of which African-Americans were worst hit compared to other racial groups. Only 74% of African-Americans were surviving five years, survival amongst whites was at 82%, Latinos 84% while Asians represented 86%. Highest numbers of injecting drug users within the area are found within Tenderloin and Western Addition (Tommasello et al., 2006). Additionally, the mean community viral load, which is known as new population-based biomarker on overall infectiousness, is prevalent amongst specific communities. These include Bay-view, South of Market, the Tenderloin, Downtown and Nob Hill. Government statistics shows that communities residing in these areas are associated with the lowest median household incomes amongst San Francisco residents. Within the mentioned population, homeless individuals are known to have the highest community viral load. Health-related Problem, Issue, or Health Risk The Human Immunodeficiency Virus (HIV) is known to inhabit bodily fluids and is lethal to immune system since it secrets its own genetic material into human body defensive mechanism. The virus affects normal functioning of white blood cells component referred to as T-cells and ultimately reduces their number. The body’s immune system weakens with reduction on the number of T-cells hence vulnerable to opportunistic infections. The last stage of its development leads to full-blown AIDS that occurs at the point the body has little immunity left (Straub, 2007). According to statistics by Centers for Disease Control and Prevention, there was an estimated 1.1 million people living with HIV infection in United States in 2006. This number included over 800 children under age 13. However, HIV/AIDS infection is found to be more prevalent in the homeless population. According to National Alliance to End Homelessness (2006) there is an estimate of 3.4% of homeless people who were found to be HIV-positive in the year 2006 (Centers for Disease Control and Prevention, 2008). There is profound relationship between homelessness and HIV infection. This is derivable from the costs of health care and medications that are often high for those living with HIV/AIDS (PLWHA). This category of PLWHA is endangered population since they are victims of job discrimination due to frequent absence owing to their health issues. This has resulted into higher percentage of PLWHA risking being rendered homeless in the United States (National Alliance to End Homelessness, 2006). Such condition of homelessness is seen as potential source of risk of contracting HIV infection. This is since a number of homeless populations are victims of substance abuse disorders such as drug abuse making them in most occasions to share needles. Such practices are considered as responsible for approximately 13% of HIV/AIDS infections in United States. Additionally, approximately 50% of infection cases results from gay sexual contacts while 33% attributed to heterosexual sex (Centers for Disease Control and Prevention, 2008). The conditions under which homeless population are subjected to may be a prime contributor to sexual behaviors that increase risk of contracting HIV. The kinds of shelters used are considered single sex hence limited privacy making it difficult for shelter population to form sustainable sexual relationships (University of California San Francisco Center for AIDS Prevention Studies, 2005). There are many health challenges facing the homeless living with HIV/AIDS some of which include poor hygiene, malnutrition, and exposure to poor weather conditions. This makes homeless people more vulnerable to illness compared to house people (National Health Care for the Homeless Council, 2008). Those having HIV infection are not immune to other diseases since HIV infection weakens immune system as described above. Poor and crowded shelters having poor ventilation is risky for PLWHA since this exposes them to other infectious diseases such as hepatitis A, pneumonia, TB as well as other body infections (National Alliance to End Homelessness, 2006). Additionally, the rate of HIV infection is accelerated through psychological factors (Waldrop-Valverde and Valverde, 2005). According to Green et al., (2008), psychological distress is a critical contributor towards severity of HIV disease. These factors are common occurrences amongst homeless people affects their behaviors and ultimately spread of HIV/AIDS. This is since conditions such as depression affects an individual’s adherence to medication that is critical for treatment of HIV/AIDS (Gore-Felton and Koopman, 2008). There is also potential indication that rate of treatment of diseases amongst homeless people is very low. This is since homelessness makes it more difficult to apply the use of antiretroviral treatments (ARTs) which is recommendable for treatment of HIV (National Alliance to End Homelessness, 2006). At the same time, majority of homeless individuals lack health insurance cover hence unable to cater for their medications and health services. Implications for HIV infection to the community The concept can be measured through initiation of superior models capable of handling the current rise in population needs, especially need for homes. The nature of prevailing disease is a function of the kind of environment people are exposed to. There is need of involving other players in environmental projects such as community-based organizations, micro-enterprises and the private sector. In order to prove the effectiveness and necessity of environmental cleanliness, there is need to makes use of background information on health of San Francisco community and determine the necessity of undertaking preventive measures at early stages of development. Indeed, immunization is the protective measure to mitigate the prevalent risk of diseases in children. However, cases of HIV/AIDS can only be controlled through extensive medical care and involvement of health ministry including individuals. At the same time, health organizations will be able to use findings on environmental cleanliness for the purposes of improving ways of administering treatments on children and community at large. This makes adults and children to have the ability of minimizing the risk of losing their loved ones to preventable illnesses (Centers for Disease Control and Prevention, 2007). Environmental preventive measures have been in use for long time in San Francisco. However, currently a majority of homeless populations in California have neglected the importance of taking care of environmental hazards (McEwen and Wills, 2011). In order to ensure adequate housing and cleanliness within the environment it is recommended that additional measures should be implemented such as more awareness campaign organized by health sectors. Influencing Change in San Francisco as a Nurse Pre-empting and ultimately HIV prevalence in San Francisco meted on vulnerable and less fortunate Gender in the society calls for a concerted, multi-pronged strategy by the union government, health organizations, and the vibrant growing corporate players. Given the stratified nature of the San Francisco society, investigating extent to which the menace has pervaded the American society; designing ,monitoring and evaluating the already in place strategies seems a complicated affair. This calls for dovetailed approach by the aforementioned stakeholders, in order to achieve expected effectiveness. Registered nurses are capable of providing efficient healthcare services within different communities in San Francisco. Environmental hazards range results of violence to psychosocial conditions within communities and work places. Such conditions can be prevented through understanding on various factors contributing to such occurrences. Environmental cleanliness is seen as the basic part of human existence since it helps in avoiding problems caused by diseases. Nurses frequently encounter people in such conditions during their nursing practices at home, in community and at workplaces. Within such proximity of analysis, nurses are considered capable of handling cases on health hazards in line with their profession. There is need for advising the homeless community concerning potential hazards and necessary steps required to eliminate cases on HIV infections. However, in addition to all these, global environmental conditions contribute results that are more negative that just affecting human health. Such analysis creates awareness on climatic changes such as increase in global temperature that is usually associated with variety of diseases such as cardiovascular and respiratory diseases (McEwen and Wills, 2011). The concept of cleanliness of environment creates an awareness on both preventive and control measures on HIV/AIDS. Cleanliness of environment leads to adoption of exposure limits set by various regions for the purposes of regulating environmental hazards. These are based on natural experimental model done within the laboratories despite the significant degree of uncertainty experienced. This includes indoor and outdoor air pollution that is considerable as the most prevalent form of pollution within most countries (McEwen and Wills, 2011). However, not all nurses are capable of handling environmental settings due to differences in training they receive. The concept helps in defining nursing profession since most registered nurses receive training mainly in hospital diploma and associate degree of which are used to provide patient care within organized settings including community-based health care. Despite all these, nurses are capable of proving assistance in leadership roles required for conducting environmental quality control measures. Various attributes are drawn from this concept such as health consciousness and mitigation of pollutants amongst others. In response to such health concerns, the concept reveals that most nurses are operating at distinctive disadvantage due to disparity between matters pertaining to public health and nursing professional practices. Health issues are usually approached from population control and preventive perspectives. This is contrary to the curative perspective that nurses are trained to undertake where focus is on patients already suffering from some kind of disease. Health specialists at times feel inadequate when it comes to handling environmental matters despite possibilities of re-conceptualizing on ways through which the profession can be used to minimize health cases. They feel comfortable caring for individuals since this defines so well the nature of their profession avoiding instances of stepping into social and political programs geared towards disease prevention mechanisms (National Health Care for the Homeless Council, 2008). Problem Description and Rationale HIV amongst homeless is clearly associated with Environmental cleanliness concept that can be used in the process of changing community perception concerning healthy lifestyle. This is found necessary in measuring the extent of utilization and underutilization of medical services within San Francisco. Considering prevalence of the diseases amongst children and adults, prevention concept focuses on dealing with causal organisms especially based on levels of sanity within community. Additionally, there is need for evaluating the impact of cleanliness and other disease controlling mechanisms within the society (Walker and Avant, 2010). The kind of environment under which nursing programs are implemented can exhibit best outcomes in the typical society under normal circumstances as opposed to areas presently prone to disease outbreaks. This is because the outcome of normal situations definitely reflects reality, unlike areas with outbreaks, which are certainly bound to reflect contemporary extremes (McEwen and Wills, 2011). Other factors contributing to prevalence of HIV include excessive use of alcohol and other drugs (Gordon et al., 2006). Rationale There is need for provision of education initiative grants capable of promoting education as one of the major intervention measures, capable of combating spread of HIV/AIDS. As revealed from the introduction, San Francisco seems to be populated by homeless community. The quality and relevance of education should be promoted amongst children and adults since there are possibilities of resource constraint and education inaccessibility to homeless community. Education initiative grants support improvements in health educational programs, access, teacher training and provision of training materials (International Labour Organization, 2003). Besides education, there is need for rehabilitative services to cater for homeless social and mental health accompanying their removal from harsh environmental situations. Such services can be provided through visits as well as establishment of residential centres. The common cause of HIV infection is attributable to lack of constant source of income. This means that families should be provided with other financial alternatives capable of meeting their sustainable and health needs. Such alternative income generation activities include training skills for family members as well as micro-finance opportunities. Conclusion In conclusion, overall responsibility of implementing environmental programs aimed at cleaning the environment rests entirely in the hands of the medical institutions and other concerned governing bodies within San Francisco and entire California. However, evaluation-nursing process plays important roles in post-implementation and administration of remedial tests and care. Implementation of housing and environmental programs requires basic information concerning public and private environmental conditions. This ensures full participation of target communities and associated programs. Generally, nursing intervention in environmental matters does not stop at the implementation stage. The process involves monitoring of the effectiveness of all programs included in the process that determines the need for remedial and preventive actions on HIV infection. There is also need for nurses to take the lead in educating target communities concerning the benefits of remaining consistent in tackling environmental health issues. Such actions ensure realization of sustainability on evaluation processes targeting long-term success. References Centers for Disease Control and Prevention. (2007).  “HIV/AIDS Statistics and Surveillance:  Basic Statistics.”  Retrieved from http://www.cdc.gov. Centers for Disease Control and Prevention. (2008). “HIV Prevalence Estimates – United States, 2006.”  Morbidity and Mortality Weekly Report.  Oct. 2008.  Available from http://www.cdc.gov/mmwr/. Centers for Disease Control and Prevention.(2012).  “HIV/AIDS in the United States.”   Retrieved from http://www.cdc.gov. Gordon, A.,J, McGinnis, K., A. & Conigliaro, J.(2006). Associations between alcohol use and homelessness with healthcare utilization among human immunodeficiency virus-infected veterans. Medical Care,44(8):S37–S43, Gore-Felton, C., & Koopman, C. (2008). “Behavioral Mediation of the Relationship Between Psychosocial Factors and HIV Disease Progression.”  Psychosomatic Medicine, 70(5), 569-574. Greeson, J.M., Hurwitz, B.E., Llabre, M.M., Schneiderman, N., Penedo, F.J., & Klimas, N.G. (2008). “Psychological distress, killer lymphocytes and disease severity in HIV/AIDS.” Brain, Behavior, and Immunity, 22(6), 901-911. Kushel, M., B., Colfax, G., & Ragland, K. 2006. Case management is associated with improved Antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection. Clinical Infectious Diseases,43(2):234–242 McEwen, M.,& Wills, E. (2011).Theoretical basis for nursing. (3rd ed.). Philadelphia, PA: Wolters Kluwer Health National Alliance to End Homelessness.(2006).  “Homelessness and HIV/AIDS.”  Retrieved from http://www.endhomelessness.org. National Health Care for the Homeless Council. (2008). “Health Care for the Homeless:  Comprehensive Services to Meet Complex Needs.” Retrieved from http://www.nhchc.org. San Francisco Department of Public Health.(2010). HIV Epidemiology Section. HIV/AIDS Epidemiology Annual Report Straub, R.O.(2007).  Health Psychology:  A Bio-psychosocial Approach. New York:  Worth Publishers Tommasello, A., C., Gillis, L., M., Lawler, J.,T., & Bujak, G.H. (2006). Characteristics of homeless HIV-positive outreach responders in urban U.S. and their success in primary care treatment. AIDS Care, 18(8):911–917 University of California San Francisco Center for AIDS Prevention Studies.(2005). What are Homeless Persons’ HIV Prevention Needs?  Retrieved from http://www.caps.ucsf.edu/ Waldrop-Valverde, D., & Valverde, E. (2005). Homelessness and psychological distress as contributors to antiretroviral non-adherence in HIV-positive injecting drug users. AIDS Patient Care and STDs ,19(5):326–334 Read More