Impact of Aids on Children and Families in Africa - Research Proposal Example

Running Head: HOW AIDS IS AFFECTING CHILDREN AND FAMILIES IN AFRICA? Impact of Aids on Children and Families in Africa sName] Contents Contents 2 Overview and Background 3 Aims and Objectives of Research 4 Research Problems 4 Aims of Methodology 9 Data Collection 9 Data Integrity 10 Limitations of the study 11 Proposed Analysis of Results 12 References 13 Impact of Aids on Children and Families In Africa Chapter 1: Introduction Overview and Background The HIV / AIDS epidemic has become a serious issue in many countries, including the underdeveloped countries. In the developed world, sexual intercourse, homosexuality as well as the sharing of needles has been responsible for the spread of HIV / AIDS in African children and families. However, the citizens of the developed world are educated and AIDS / HIV prevention programs have met with greater success despite the sexually permissive cultures. HIV prevention has become a critical global issue because more then 42 million people are infected with HIV / AIDS globally and it has been estimated that another 45 million will become infected unless significantly improved prevention efforts are attempted with success. The World Health Organisation has estimated that every year about 5 million new people become infected with the HIV / AIDS virus. The prevention of HIV / AIDS mostly involves educating individuals including those of the gay community about dangers of sex without precautions. Testing and identification of HIV / AIDS victims, along with their appropriate care should be a part of the public health programs to arrest the spread of HIV / AIDS in African children and families within a community. There are costs associated with prevention programs for arresting the spread of HIV / AIDS in African children and families. Resources for the prevention of the spread of HIV / AIDS in African children and families virus are limited and those funds that are available are insufficient for meeting all the prevention needs in most communities. The cost of the HAART treatment includes the cost of AZT, Lamivudine and Nevirapine required for the first line treatment or the cost of Didanosine, Stavudine, Lopinavir, and Ritonavir for the second line of treatment. Pediatric costs associated with the treatment of HAART are presently highly variable (Geffen, 2003, Pp. 12 – 20). Aims and Objectives of Research This paper shall study the impact of Aids on children and families in Africa. This paper shall study the depth of the problem and the various ways and means, which can be adopted in order to mitigate the devastating impact of this un-curable disease. It shall also aim at analysing information from these areas in order to make the paper more relevant to the ground realities and shall discuss the various tools and techniques, which can be adopted in order to psychologically strengthen the disheartened and deplorable conditions of the patients and their families. Research Problems This paper shall try to answer the following research problems: 1) Analyse the impact of Aid on Children 2) Analyse the impact of Aid on Families 3) Analyse the reasons behind the rampant spread of this disease 4) Suggest changes in environment and culture needed to bring about an improvement in the current situation 5) Provide recommendations on the studied literature and research Chapter 2: Literature Review Studies by international organisations including the World Bank have determined that successful HIV / AIDS prevention and treatment programs on the national level, which are being funded by international efforts, require government commitment at the highest level with a partnership between the public and the private sector. Attempts towards prevention should be started early and there should be cooperation and collaboration between the community and religious leadership. There is a requirement for a forward looking, comprehensive and multi-sectoral response and community participation in the formulation of government policy is desirable. It has been observed that centralised programmes led by a national ministry of health do not work and neither does the inadequate targeting of programs to small sections of the population at high risk. The World Bank has, therefore, assisted with efforts on a national level, which have been targeted towards the prevention of HIV / AIDS in which funds have been channelled directly to community, civil society and the private sector with an involvement of multiple agencies, especially community based and NGOs. A Global Fund for the eradication of HIV / AIDS was launched in 2002 and this gave the financial experts of the bank considerable influence to administer proposals submitted through a country coordinating mechanism, which were also required to reduce stigma and discrimination. Some objectives of a national program against the disease include attempts to survey and measure the scale of the epidemic, attempts to reduce the transmission of the virus, ensuring safety of blood transfusions, promotion of educational and information activates aimed towards reducing the spread of the virus through sexual activities, assistance with the psycho-social and the clinical care of the sick and attempts to promote research (Putzel, 2004). As the less developed countries are attempting to globalise their economies and these economies have failed to take off, there are precious little funds to allocate to the HIV / AIDS interventions. In view of the economic impact, there is a requirement for government intervention and although there is no cure for HIV / AIDS, tools are available for prevention. Counselling and support, income generation programs and foster care placements have also been cited as being necessary for HIV / AIDS related interventions. Workplaces can also serve as a place for educating and disseminating information about HIV / AIDS. Prevention interventions assist in the control of the transfer of the virus from one individual to the other and are beneficial in controlling the spread of HIV / AIDS in African children and families. Individuals on HAART, therefore, save the health system additional funds to treat opportunistic infections. Well-designed interventions can reduce the cost that has to be incurred by a health system in dealing with HIV / AIDS. The success of an intervention may be measured in terms of the cost per case of HIV / AIDS averted and the cost per disability - adjusted life – year or DALY that may be provided to a sufferer. A combination of interventions may be used in attempts to control the spread of HIV / AIDS in African children and families and to prevent suffering as well as enhancing the quality of life (Geffen, 2003, Pp. 3 – 7). Treatment interventions may consist of treatment of opportunistic infections only, prevention interventions and treatment of opportunistic interventions and treatment with antiretroviral medications by using HAART therapy along with prevention and the treatment of opportunistic interventions. Hence, various interventions are possible with varying costs and associated benefits. HAART treatments may be provided to adults or children. Some cost parameters such as salaries for employees and councillors are common to all interventions, but other program costs may make various interventions to have different costs and provide varying benefits. Costs of drugs for HAART depend on whether it is a first line intervention or a second line intervention. Adult and paediatric HAART treatments are by far the most expensive as compared to prevention measures. Treatment and prevention option provides the most considerable benefits for a national population but this option also costs the most. However, the treatment and prevention option results in a lower overall cost to the government if the costs associated with providing hospitalisation, morbidity and the costs of dealing with orphans is considered. Because cost – effectiveness is the most important criterion on which resources are allocated for public health, therefore it is considered important that the HIV / AIDS epidemic be attacked by both prevention as well as treatment interventions. Economic approaches to designing HIV / AIDS interventions are therefore of importance because those who design these interventions are often confronted with a very wide variety of choices for interventions but very limited funds to implement these choices. Economic techniques such as cost analysis, cost – benefit analysis or CBA, cost – effectiveness analysis or CEA and cost utility analysis or CUA. The simplest form of analysis is cost analysis, which evaluates the costs associated with an intervention, taking into account the cost of inputs, the methodology associated with an intervention and incremental costs as well as cost recovery etc. The cost – benefit approach assigns a monetary value on the cost of an intervention program along with the benefits accrued from the intervention in terms of the health of individuals. Literature has indicated that condom distribution in Sub – Saharan Africa with a cost of about £ 38 per HIV / AIDS infection averted is the most cost effective (Forsythe, 2004, Pp. 43). Cost - utility analysis takes into account the additional number of years that can be provided to a HIV / AIDS sufferer because of an intervention and the quality of these years. Whereas condom distribution has a cost – utility analysis value of £ 47 per DALY gained, HAART has a cost – utility analysis value of £ 10,000 per DALY gained. Some important studies, which provide statistical data and its analysis related to the HIV / AIDS epidemic in Africa, have been investigated by the Social Aspects of HIV / AIDS and Health Research Allianse or SAHARA. Chapter 3: Proposed Methodology Aims of Methodology The primary aim of the study shall be to take a close look at the incidence and prevalence of the HIV / AIDS in Africa and try to recommend intervention strategies in the light of the costs associated with the treatment or prevention interventions for the virus. Those who have become infected with the HIV virus can only have their lives prolonged and steps can be taken to minimise the risk of the spread of infections from these carriers of the virus. Ethical requirements demand that these individuals be provided the HAART treatment at the minimal possible costs, but as has been pointed out in (Tribble et al., 2005), despite such treatment, the ultimate destiny of such individuals is death. Data Collection Primary data shall be collected by designing a number of questionnaires for adults or for the guardians of children who shall be too young to participate in the sampling exercise by themselves. Questionnaires shall be designed for children in the 2 – 11 years age group, 12 – 14 years age group and another questionnaire for adults. The questionnaires shall attempt to collect information about demographics, HIV infections in African children and families, sexual activities or knowledge of sex and HIV, religious affiliations, parental mortality, orphan status, traditional health practices, circumcision status and general health status. Research participants in the primary sampling exercise shall be required to be informed about the purpose of the exercise and VCT needed to be offered if desired. Verbal consent shall be required to collect saliva for testing from children. The sampling teams shall be adequately trained in order to handle sensitive and personal questions that shall be needed to be asked for the primary sampling. Field workers shall be monitored and names of persons providing answers or samples shall be not recorded. Data Integrity The data that is collected for the studies that are of significance including (Strebel, 2004; Tribble et al. , 2005; Brookes, 2004 and Shisana, 2002) shall be obtained as primary data from household surveys involving testing for HIV infections in African children and families using saliva tests and the distribution of questionnaires. Random samples of the population in a locality shall be selected by identifying selected residential areas through satellite images of the localities. The requirements to provide answers to the questionnaires distributed and to be tested for HIV by the use of the saliva test shall be voluntary and households could decline to provide answers or be tested. This is in line with the ethical requirements for medical research. For the purpose of the discussion in this dissertation, primary data could not be directly acquired and only the data available from published sources such as those mentioned previously shall be used. Another method of collecting primary data from a sample of the population shall be to concentrate on segments of population who could be readily tested or interviewed. An example of such a population segment is the public school teachers in the African education system who could be readily interviewed about the impact of the antiretroviral program and its impact (Tribble et al., 2005). Despite the attempts of those who conducted the primary surveys, some sections of the community refused to participate in the sampling and hence it shall be difficult to ascertain with a high level of certainty, the prevalence of HIV / AIDS in some communities. Children under two years of age shall be not included in the national study to determine the prevalence of HIV / AIDS in Africa (Shisana, 2002). Infants shall be, however, included in the studies designed to study the prevalence of HIV amongst children (Brookes, 2004, Sections 2 – 3) and the questionnaires related to them shall be answered by their parents or guardians. Because this dissertation depends on the quality of the primary data, which shall be collected by researchers in Africa by sampling, therefore, it is appropriate that sources of secondary data be evaluated by considering the quality of the organisations and researchers, which shall be involved in sampling for the primary data. The studies presented in (Strebel, 2004; Tribble et al., 2005; Brookes, 2004 and Shisana, 2002) shall be all conducted by well-qualified professionals working under the umbrella of well-regarded professional organisations. Limitations of the study The limitation of the studies arises out of the difficulties of dealing with causality. Although sampling for data from the population requires that the current infections be investigated, however, the very nature of the AIDS / HIV infections in African children and families can mean that maybe some individuals ought to be infected up to ten years ago, with the virus being in the dormant state in their bodies. Because the HIV virus can remain dormant in the human body for years, it can be difficult to link infections that may occur at a time with possible causes that may exist currently. Participants may also provide answers to questions, which they think, are socially acceptable and there is no way to find out if they are telling the truth. The studies shall focus on individuals who shall be living in homes and neglected those who shall be living in transitionary abodes such as hotels or dormitories and thus here may shall be a failure to take into consideration certain children and families who may shall be playing an important role in the spread of the HIV virus. These children and families include homosexuals, lesbians, sex workers, homeless individuals, soldiers, students and nomadic people. Due to cultural reasons, some children and families in the community at large may have refused to participate in the sampling. Hence, there is a level of uncertainty, which exists despite the efforts made in collecting the primary data (Shisana, 2002, Pp 11 - 92). Proposed Analysis of Results The results can be processed in a number of ways. Having determined the number of HIV infected individuals in a population, it is possible to calculate the cost of a treatment intervention if 50% of the population participates in the program. The mean survival time from treatment interventions can be calculated and the cost associated with this can be found. For preventive programs, it is possible to calculate the cost per person for those who are participating in a program. Preventive programs can be voluntary counselling and testing or VCT programs, mother to child transmission prevention program or condom distribution program. The effectiveness of an intervention can be calculated by projecting the number of HIV infection cases that are likely to occur from historical screening data and the actual number of new HIV infections in African children and families that do occur after a preventive intervention. Hence, it is necessary that HIV testing and screening data be available for a population because without the availability of this data, it is not possible to know what is going on or how to evaluate the effectiveness of a medical intervention (Masaki, 2004; Brandeau, 2005 and Spring Mill Medical School, 2005). Nearly all data that is available in literature for HIV / AIDS in Sub – Saharan Africa is processed data. Data collection is possible by multiplying unit costs with the number of individuals who avail a program intervention. Raw data can also be collected by distributing questionnaires containing relevant questions, which may be answered by individuals or patients (Bautista, 2003, Pp. 13 – 16). References Bautista, Sergio Antonio et al. (2003). Costing of HIV / AIDS Treatment in Mexico. Patterns for Health Reform Plus. Brandeau, Margaret L, Gregory S. Zaric and Vanda De Angeles. (2005). Improved Allocation of HIV Prevention Resources: Using Information About Prevention Program Production Functions. Brookes, Heather et al. (2004). The National HIV Prevalence and Risk Survey of African Children. Social Aspects of HIV / AIDS Research Alliance. SAHARA. Cooper, M. H. & Culyer, A. J. 1973, Health economics: selected readings Harmondsworth: Penguin Books. Forsythe, Steven. (2004). Approaches to Economic Evaluation of HIV / AIDS Interventions. Family Health International. Geffen, Nathan. Nicoli Nattras and Chris Raubenheimer. (2003). the Cost of HIV Prevention and Treatment Interventions in Africa. University of Cape Town. Great Britain. Department of Health 2001, National service framework for older people [London: Department of Health]. Masaki, Emiko et al. (2004). Cost Effectiveness of HIV Prevention vs. Treatment Strategies for Resource Scarce Countries: Setting Priorities on Aids. University of California, Berkley. Putzel, James. (2004). The Global Fight against AIDS: How Adequate is the National Commissions? London School of Economics. Shisana, O. (1999). ‘Gender mainstreaming in the health sector. Women and Health’. Report of the expect group meeting 28 September–2 October 1998. United Nations. Spring Mill Medical School. (2005). Academic Model for the Prevention and Treatment of HIV / AIDS (AMPATH). Indiana State University. Strebel, Anna. (2004). the Development, Implementation and Evaluation of Interventions for the Care of Orphans and Vulnerable Children in Botswana, Africa and Zimbabwe. Human Research Council. Tribble, D.R. et al. (2005). ‘Comparative field evaluation of HIV rapid diagnostic assays using serum, urine and oral mucosal transudate specimens’. Clinical Diagnostic Virology, 7: 127–32. Read More