Concepts of epidemiology (HIV)
Concepts of epidemiology (HIV)
Communicable diseases are global health issues nowadays as the world become globalized by increasing international travel and business. Among many of communicable diseases, Human Immunodeficiency Virus (HIV) infection is considered to be one of the most severe communicable diseases worldwide. It has spread rapidly throughout the whole world from the continent of Africa since it was first reported in 1981(Maurer & Smith, 2009). By 1987, it had spread to 100 countries, by 2001, HIV became the leading infectious cause of death in the world. Scientists believe a similar virus to HIV first found in animals such as chimps and monkeys in Africa, where Africans are hunted for food. While they contact with an infected animal’s blood during butchering or cooking, the virus might cross into humans and become HIV (Mayo Clinic, n.d.). HIV causes acquired immune deficiency syndrome(AIDS). Having HIV does not always mean having AIDS.
To develop AIDS, it take many years for people with HIV. The epidemic of HIV/AIDS in Africa is devastating because it disrupts family life, leaving many children without parents’ support. Reduced workforces in African society impact socioeconomic issues as well. These days, HIV/AIDS are not only problems in the African continent, but they are now also seen in every continent in the entire world. As of 2008, United Nations (UN) general assembly special session on HIV/AIDS estimated that there were roughly 33-4 million people living with HIV, 2.7 million new infections of HIV, and 2 million deaths from AIDS. According to the Center of Disease Control(CDC), about 1.1 million people in the U.S. had been diagnosed with AIDS since the disease diagnosed in 1981(Maurer & Smith, 2009). A person gets HIV when an infected person’s body fluids such as blood, semen, fluids from vagina or breast milk get into his or her bloodstream.
This virus can enter the bloodstream through linings in the mouth, anus, or sex organs through broken skin. HIV attacks and destroys CD4 cells which is same as T-cells in white blood cells (Moss, 2013). When a person has lower number of CD4 cells in the blood than normal, he or she is susceptible to illnesses because the person lost ability to fight infection. Unsafe sexual activity, transfusion of HIV infected blood, sharing needles and syringes with people with HIV, HIV infected mothers’ pregnancy, delivery, and breast-feeding are all risk factors for HIV infection. World Health Organization(WHO) found that 80% of cases of HIV/AIDS infections happened by unsafe sexual contact with an HIV-infected person. Stigma, discrimination, misconception, local social and cultural taboos also contribute to increasing number of HIV infections in developing countries where people do not talk about them or people are not educated about them.
Early symptoms of HIV infection are fever, fatigue, swollen lymph nodes, diarrhea, weight loss, cough, headache, blurred and distorted vision, skin rashes or bumps, and shortness of breath(Moss, 2013). People infected with HIV progress to AIDS when their CD4 cell count falls down below 200 or when they develop complications such astuberculosis, salmonellosis, cytomegalovirus, candidiasis, cryptococcal meningitis, toxoplasmosis, cryptosiporidiosis, and cancers including Kaposi’s sarcoma and lymphomas. Other complications can include wasting syndrome, neurological complications, and kidney disease(Moss, 2013).AIDS is the last stage of HIV infection and life threatening. If a person with HIV does not receive treatment, the disease progresses to AIDS in about 10 years (Mayo Clinic, n.d.). Good news is that there is a treatment with antiviral medication for HIV infection even though there is no complete cure for HIV/AIDS. As soon as a person is diagnosed as HIV-positive, a variety of drugs can be used in combination to control this virus.
The Department of Health and Human Services recommend that everyone with HIV infection must be offered antiviral medications regardless of T-cells count in order to restrict replication and duplication of the virus. HIV medications are more widely available than ever. They expand the lifespan of people with HIV. Not only drug regimen, but healthy life style such as eating healthy foods including fish oil and whey protein, avoiding certain foods including unpasteurized dairy products, raw eggs, and raw seafood, getting vaccine, obtaining coping skills contribute to reducing further complication of HIV/AIDS (Mayo Clinic, n.d.). Prevention is the most important through education on safe sexual activity, safe care of blood transfusion, protective care of pregnancy, delivery, and breast-feeding among mothers with HIV/AIDS, etc. The epidemiologic triangle is composed of agent, host, and environment.
These three are interrelated to spread the communicable diseases such as HIV/AIDS. For example, the agent factor is the presence or absence of human immunodeficiency virus that is transmitted directly through infected blood transfusion, sharing infected needles and syringes, and breast feeding from infected mother or indirectly through broken skin by unsafe and unprotected sexual contact. The host factors are people. They can be either HIV-positive or HIV-negative. People who are diagnosed as HIV-negative are susceptible hosts who can be infected by people who are diagnosed HIV-positive if they have unsafe sexual activity or receive unsafe health care. The environmental factors can be social and economic conditions such as poverty, crowding, and frequent mobility of people that carry agents easily to other environments. If the environment is less habitable, the host susceptibility is reduced, and the agent source is also reduced or eliminated as well. All three factors may be altered to improve community resistance to HIV infection (Maurer & Smith, 2009)
Figure 1 HIV Epidemiologic Triangle
The community and public health nurses play an important role through their tasks such as case finding, reporting, data collection and analysis, and follow-up. 1. Responsibility of primary prevention; Community and public health nurses are in the front line to assess a person, family, and communities for epidemiologic agents, susceptible hosts, and favorable environments. Nurses are responsible for educating people in the community about the causes and spread of the virus. Since 80% of HIV infection occurs by sexual contact with an HIV infected person, abstinence or advocacy of the use of condoms and other protective measures during sexual activity must be taught to people of all ages at risk, young or old, male or female. Safe administration of blood, safe use of needles and syringes, safe breast-feeding, and protective health care of mothers with HIV during pregnancy or delivery must also be taught and performed as well for primary prevention. 2. Responsibility of secondary prevention: Despite education and prevention efforts, reducing HIV infection is challenging. In 2009, CDC reported, youth, ages 13-29, accounted for 39% of all new
HIV infections in the U.S.(Albright & Gavigan, 2014). Nurses are responsible for secondary prevention through effective intervention. There is no cure for HIV/AIDS , yet medication regimen help improve life expectancy by preventing HIV-related complications. Combination of medications at least three of antiretroviral can be used to control the virus(Moss, 2013). Nurses should encourage people who receive antiretroviral therapy of 3 to5 combination pills to be compliant with prescribed medications as scheduled. However, combination of antiretroviral cost a lot and are not available in poor countries. WHO support these countries that drug companies provide medications at low cost.
Community health care providers suggest voluntary counseling and testing for HIV treatment programs as good strategies. By the help of trained counselors, patients in the community can learn their HIV status and register for treatment as needed. In South Carolina, since the number of young adults with new HIV infection is increased, a new intervention program is designed for young adults that is called HIV/AIDS information vaccine, using graphic novels(Albright & Gavigan, 2014). 3. Responsibility of tertiary prevention; Since HIV/AIDS is incurable and at risk in progression gradually, community and public health nurses can focus on enhancing or optimizing their quality of life.
HIV is not only a physiological stressor, but also a significant psychological stressor. Many of HIV positive patient suffer with depression and suicidal ideation. According to the study, these psychological symptoms among HIV-positive people are associated with a decline in CD4 cell count (Dalmida, 2006). By evidence of research, depressive mood affects neuropeptide receptor on lymphocytes and lead to decreased CD4 cell count(Dalmida, 2006). Spiritual practice and mental care for HIV-positive people are beneficial to relax sympathetic nervous system and enhance immune function (Rabin 1999). According to the holistic view of human being, an awareness of one’s spiritual self is very important to extend life span with optimal wellness increasing greater satisfaction with life. (Rabin, 1999).
Community and public health nurses have a role in such responsibilities in order to make a person, family and community different and healthier by providing coping skills with spiritual activities for people who are infected by HIV and who are suffering with AIDS. AIDS United is an organization that carries its mission in the U.S. to end the epidemic of AIDS since 1987. This organization has funded to local communities for syringe access, access to care, capacity building, HIV prevention and advocacy. AIDS United supports community-driven to HIV epidemic around the nation that reach populations with HIV/AIDS including gay and bisexual men and women, adolescents in school.
Albright, K.S., Gavigan, K. (2014) Information Vaccine: using Graphic Novels as an HIV/AIDS prevention resource for young adults. Journal of Education for Library & Information Science; Spring 2014, Vol.55 Issue 2, p178-185. Retrieved from GCU library. Coleman, C.L., Holzemer, W.L. (1999). Spirituality, psychological well-being and the quality of life. In L.A. peplau & D.Perlman (Eds), Loneliness: A sourcebook of current theory, research, and therapy (pp.224-237). New York: Wiley-Inter-science. Retrieved from Grand Canyon University(GCU) Library. Dalmida, S.G. (2006). Spirituality, Mental Health, Physical Health, and Health-related quality of life among women with HIV/AIDS: Integrating spirituality into mental health care. Issues in Mental health nursing. Vol. 27. Retrieved from GCU library. Maurer, F.A., Smith, C.M. (2009) Community/Public Health Nursing Practice: Health for families and populations (4th ed.)[Saunders Version] Retrieved on June 5, 2014 from http://evolve.elsevier.com Moss, J.A. (2013) HIV/AIDS Review. Journal of Radiologic Technology, 2013 Jan 1; 84(3) pp. 247-270. Retrieved on June 5, 2014 from GCU library. MayoClinic (n.d.). Retrieved on June 5, 2014 from http://www.mayoclinic.org/disease-conditions/hiv-aids/basics/causes/con-20013732 U.S. Centers for Disease Control and Prevention(CDC) http://www.cdc.org/cough/index.htm World Health Organization(WHO) http://www.who.int