Developing an Intervention for HIV AIDS Population

¶ … HIV patients.

Identify and Describe the Aggregate

This paper focuses on a particular section of HIV patients - that of men having sex with men, in the United States. There is also an identification and description of the aggregate, its needs and risk factors. The advantages, applications, limitations and adaptability of the interventions for the aggregate form the bulk of the discussion in this paper.

In almost every country in the world, it can be said with certainty, that there are men who have sex with men (MSM). Globally, however, this is a very diverse group. Some of these men label themselves as bisexual; others as gay and a large number simply refer to themselves as heterosexual men who just have sex with other men. In the global HIV and AIDS context, sex between men is a key front in the fight against the spread of this disease, because such sex involves primarily anal sex -- a practice that carries a high risk of HIV transmission when no protection is used. In history, AIDS was first discovered among gay men in the United States, and since then up-to-date, high rates of HIV infection have consistently been found among MSMs in many other countries (Avert.org, 2014).

Bisexuals, gays and other MSM groups represent about 2% of the U.S. population, yet they are the part of the population that is most affected by the HIV scourge. In the year 2010, for example, young bisexual and gay men (between the ages of 12 and 24) accounted for 72% of new HIV infections in that age group, and 30% of new infections among all MSMs. In 2011, it was estimated that approximately half a million people (57%) of the people living with HIV in the U.S., were MSMs. These new infections occurred either through unprotected sex or sharing syringes when injecting drugs (CDC, 2015).

White bisexual and gay men accounted for 38% (11,200) of all new HIV infections in the U.S., in 2010. The largest proportion of these new infections (29%) occurred in the 25-34 age set. New infections among African-American bisexual and gay men accounted for 36% (10,600) of 2010's estimated new infections. The largest fraction of new infections, 45%, occurred in those aged between 13 and 24. Hispanic bisexual and gay men accounted for 22% (6,700) of estimated new infections in the same year. The largest number of new infections in this group, 39%, occurred in those aged between 25 and 34 (CDC, 2015).

Background on HIV Infection

Human Immunodeficiency Virus (HIV) infection is a recently recognized infection whose realization is not older than 30 years. Its spread was wide and fast, prioritizing it as a public health issue in many nations. A multidimensional approach needs to be deployed towards the mitigation of the HIV impact as its effects spreads to a variety of life facets. HIV continues to be an important research subject for the clinical, basic, as well as social, scientists given its effect in the three disciplines (Shete, 2013).

HIV prevalence estimates differ greatly in different nations as well as on regional basis in quality of affliction, yet an overall regional trend can be recognized easily. Amongst the worldwide regions, the hardest hit by HIV prevalence is the sub-Saharan Africa, with 70% of the population coping with HIV / AIDS. In Africa, there is a distinct decrease in the number of new acquired HIV cases, since 2000, giving hopes about a better control in this region. Most Asian countries have not witnessed an explosion in the epidemic viewed from the general population to date but the Injecting Drug Use (IDU) patterns and sex work prevalence create an environment that facilitates the spread of HIV and therefore there still is the need to remain alert. The lack of prediction in the IDU epidemics in the earlier Soviet Union region is potentially viable to spread to the general public. Some Caribbean and Central America countries have exhibited a continuous growth pattern in the HIV epidemics with its prevalence to the adults lagging only the Sub-Saharan Africa region. Mortality and morbidity reductions via the usage of highly active antiretroviral therapy are at present limited in some Latin American nations towing to the low income levels. There is need for improving both the poor health care delivery frameworks and the therapy cost in the majorly affected nations to realize the benefits of the anti-retroviral drugs to arrest spread of HIV / AIDS (Morison, 2001).

The Human Immunodeficiency Virus (HIV) epidemiology in the United States of America has experienced a significant change since the early 1980s when the epidemic affected the middle-class, white, young men predominantly, who engaged in sexual relations with other men (MSM) resident mainly in the larger East and West Coast cities. Presently, HIV is an infection with a far more demographic diversity, influencing all age sets, races, sexes, and the income levels; with an involvement in multiple transmission risk factors; together with a broadening geographical distribution in the United States. Though only 12% account for the African/Black Americans residing in the United States (U.S.), they form a statistical 46% of the entire affected populace in 2006, living with HIV in the United States, in comparison to the Latino/Hispanic populace (18%), the whites (35%), and others. The prevalence of HIV among the African-American populace (1715/100,000) almost rated 8 times the populace rate among the whites (224/100,000). A 15% account for the U.S. populace by the Latinos/Hispanics prior to the 18% account in 2006 of the populace living with HIV. The Latinos/Hispanics (585/100,000) populace's overall prevalence is nearly thrice the rate for the Whites (224/100,000) (Morison, 2001).

Explain and describe at least three (3) needs of the aggregate

Psychosocial assessment of newly diagnosed HIV-infected patients

The initial assessment and counseling aided to the newly diagnosed patients is of a grave significance. The intake assessment's objective is to bring into consideration the aspects of life's current functional needs such as the social function, occupational function, and the sources of support. A set up on the prioritized areas of services and needs concerning the main agenda is required for an initial assessment. A necessity of reference to other professional referrals with inclusion to dietitians, social workers, and clinical psychologists may be mandated if the need arises in the course of the interview. The knowledge base on the infection of HIV and the current status of health is reinforced, the misunderstandings of myths are clarified, and the patients are assisted in setting up their realistic expectations. A mode of encouragement is reinforced on the patients towards an open discussion about their worries and concerns with the health care workers (Chan, 2015).

Support Group and counseling

The function of the patient support groups is of grave importance to the affected patients. There is a provision of a sharing forum for experiences and feelings, resources and treatment information, and thereby lessening the feelings of negligence and isolation. A discussion opportunity is given to the "People Living With HIV / AIDS"(PLWHAs) in relation to an open forum on the HIV issue amidst the support groups. In Hong Kong, the formation of the patient support groups is at the specialist clinics where medical treatments facilitate health care. The various Non-Government Organizations (NGOs) too, provide important support by forming groups. The facilitation of regular and rapport contacts among the HIV patients are the necessary requirements towards an effective and safer sex knowledge promotion. The health care workers need a level preparation in discussing the sex topic in order to master their skills in addressing the health needs of their patients. The safer sex education has clinical dimension settings with inclusion to: (a) the assessment of the risk behavior, the individualized level of STDs counseling prior to screening, (b) the proper condom use education and (c) the safer sex practice and counseling on its importance. Partners/spouses shall receive an invitation in order to understand the barriers and difficulties in sexual relations before adhering to the recommended counseling (Chan, 2015).

Privacy

Treating, Diagnosing, and Discussing HIV / AIDS is a private and sensitive topic between the provider and his or her patient. Lack of privacy is causal to discrimination or stigmatization of the HIV / AIDS patients. The appropriated sharing of the patient's information needs a calculated balance in regards to security and privacy. The maintenance of the patient's security and privacy is at potential risk by the health IT, but accounts for many potential benefits to the HIV / AIDS patients. Some instances call for the revelation of the patient information to a third party such as the public health authorities in order to monitor the infection rate of the maladies (U.S. Department of Health and Human Services, 2015).

Describe and identify at least three (3) risk factors of the aggregate

IDU

About 10% of all new HIV prevalence is caused by the IDUs as of 2005 but a 33% account for all HIV prevalence cases in the outcasts of the sub-Saharan Africa. An estimate by Aceijas et al., in 2004, speculates that 4/5th of IDUs globally, resided in the developing nations. The nations with majority attributes to the HIV prevalence in relation to IDUs as of 2005 include Vietnam, Nepal, Indonesia, China, Iran, the central Asian republics, Ukraine, and Russia. Equipment borrowing and lending, and the sharing of needles are tantamount to the individual level risks towards the infection of HIV among the IDUs. There is consistency in the findings in reports drawn from Tajikistan, China, Russia, Thailand, and Iran. The HIV prevalence owing to sexual risks are a consistent inference from a variety of studies as a significant disease acquisition agent. The "dual-risk" of injection and sexual profiles may be of a specified importance among the adult MSM IDUs and the female IDUs. A recognized protection against the HIV prevalence has been the Opiate substitution therapy, in addition to access to syringe and needle exchange programs as a comprehensive prevention service (Beyrer, 2007).

Men who have sex with Men (MSM)

Since the United States recognized its first HIV and AIDS prevalence, its effect on the MSM has been disproportionate. As of 2003, the Disease Control and Prevention Centers in the United States estimated the new cases of HIV prevalence to 63% amongst the MSM. The prevalence amongst the minority populace of the MSM in the United States was more and growing especially amongst the black MSM, as of 2006, when an individualized-level risk drew a comparison in relation to the white MSM in the United States. As of 2005-2006, there came an emergence of a new epidemic trend with prevalence rates of the HIV infection amongst the MSM in developing nations increasing rapidly with no links to the heterosexual prevalence (Beyrer, 2007).

Non-ulcerative sexually transmitted diseases

The heterosexual HIV-1 is spreading globally. The probable transmission rate of HIV-1 is quite low in relation to a single sexual contact, but a variety of cofactors may greatly enhance it. STDs such as genital ulcers may qualify as one of the cofactors. The facilitation of the HIV-1 prevalence by other STDs is by far weak epidemiological evidence (Laga, et al., 1993).

Condom Fatigue

This is a term used to describe the weariness experienced by those tired of condom use. It somewhat signifies the decreased success of prevention campaigns, and is linked to increased transmission rates among men having sex with men.

Unprotected Anal Sex

In 2011, men having sex with men accounted for over 50% of all new infections in all the states, except two. The fraction of MSMs having unprotected anal sex in the last one year to the study, had increased from 48% in 2005 to 57% in 2011 (CDC, 2013).

Multiple Partners

The risk of contracting HIV virus more than doubled for MSMs who had more than one receptive anal sex partner in the last 24 months, in the United States. Multiple sex partners and sexual concurrency may contribute to high levels of HIV incidence among men having sex with men (Garcia, Duong, Meyer, & Ward, 2014).

Identify two health interventions for the HIV population

Enabling people to know their HIV status

An increase in the number of individuals with the knowledge of their HIV status through counseling prior to a HIV test is a HIV prevention measure and key to access to treatment and care. The WHO provides guidelines on counseling and testing for HIV aims at achieving the synergies between the public and clinical health, the human rights, and the medical ethics objectives. The fundamental principle behind the HIV testing requires that it be mandated by the basic pre-test information to assist the client in making a decision that is informed and voluntary prior to the test. The 'three Cs', informed Confidentiality, Counseling, and Consent, are an important pre-requisite as they address both the adolescents and the children. The WHO/UNAIDS policy addressing the HIV counseling and testing falls into two major categories

i) The Client-Initiated Testing and Counseling for HIV (CITC);

ii) The Provider-Initiated Testing and Counseling for HIV (PITC)

The following apply for both categories: a provision of an informed consent will only be possible if pre-test counseling is allowed for the individuals willing to be tested. The HIV-negative individuals should learn how to maintain a HIV-free lifestyle after testing. The HIV-positive individuals should learn the ways of preventing further transmission by maintaining their own good health. They should additionally sign up for referrals and clinical assessments from approved services (WHO, 2009).

Promoting and supporting condom use

The correctness and consistency in the use of the male condoms may reduce the sexually transmitted risks of the HIV prevalence by about 80% to 90%. The same statistics also applies to female condoms. Vital HIV prevention techniques incorporate giving free condoms to those most in need, and guaranteeing that condoms are accessible to all sexually active individuals. Social advertising helps propagate methodologies that engender the interest and supply of condoms at a subsidized cost. The promotion of female and male condom utilization ought to be scaled up as a comprehensive HIV counteractive action program. The programs ought to guarantee that quality condoms are available to the individuals who need them most, and when they require them, and that individuals have the knowledge base on condoms and the required skills on their use to use them effectively and reliably. Male and female condoms ought to be made universally accessible to all individual at a sexually active age (16 years and above), either free or at a lowered cost, and it ought to be promoted in ways that will overcome the social and individual obstacles towards their use. For the few high risk populaces, for example, the men who engage in sexual relations with other men and the male sex workers, the provision of water-based lubricants is imperative (WHO, 2009) (WHO, 2009).