Assignment: HIV Epidemiology Paper

A communicable disease is transmitted from human to human, from animals to humans, or brought to humans through vectors like insects. Most communicable diseases are firmly ingrained in human communities and are often taken for granted. Most communicable diseases are associated with substandard levels of environmental sanitation, malnutrition, poor social and economic status, and general ignorance of simple lifestyle practices that help to avoid infection. The purpose of this paper is to describe HIV, social determinants of health related to HIV, the community health nurse role, and the global implication of HIV.

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HIV

HIV infection is caused by a virus, the human immune deficiency virus. It has two major strains, HIV-1 and HIV-2. HIV belongs to a family of viruses called retroviruses. It is transmitted primarily through three ways sexual, parenteral, and perinatal. Sexual transmission occurs through anal, genital, or oral sexual contact when mucous membranes are exposed to infected semen or vaginal secretions. Parenteral transmission occurs when sharing needles or equipment contaminated with HIV-infected blood or receiving HIV-contaminated blood products (Chen et al., 2019). Besides, perinatal transmission is from the placenta, when there is contact with maternal blood and body fluids during birth, or from breast milk from an infected mother to the baby. The asymptomatic phase of HIV infection is usually benign. Generalized lymphadenopathy is often a common presenting symptom (Parekh et al., 2018). The clinical manifestations depend on the stage of HIV infection. HIV is associated with opportunistic diseases and infections. The most serious ones are Pneumocystis jiroveci pneumonia Kaposi’s sarcoma, and Mycobacterium avium complex (MAC) (Parekh et al., 2018). The other important opportunistic diseases are TB, Toxoplasmosis, CMV infection, Candidiasis, and Non-Hodgkin’s lymphoma.

The cure for HIV does not currently exist, and treatment aims to reduce the viral load, prolong survival, and improve quality of life. Antiretroviral therapy is the mainstay treatment for patients with HIV. Antiretroviral agents for HIV infection include Nucleoside reverse transcriptase inhibitors, Non-nucleoside reverse transcriptase inhibitors, Protease inhibitors, Entry inhibitors, and Integrase inhibitors (Govender et al., 2021). In addition, prophylactic antibiotics are used to prevent opportunistic infections. They include Fluconazole (Candidiasis and Cryptococcus), Acyclovir (HSV), Azithromycin (MAC), and Co-trimoxazole (Toxoplasmosis and Pneumocystis pneumonia)

CDC data shows that in 2020, 30,635 persons aged 13 and above were diagnosed with HIV in the U.S. In 2020, men who have sex with men (MSM) accounted for 71% of new HIV diagnoses in the US. African American MSM made up 26% of new HIV diagnoses and 39% of MSM HIV diagnoses, while Hispanic/Latino MSM accounted for 21% of new HIV infections and 31% of infections among the MSM (HIV.gov, 2022). Globally, approximately 1.5 million people got infected with HIV in 2021. Out of this, 1.3 million were adults and 160,000 were <15 years. Most HIV infections are in low- and middle-income countries. In 2021, 20.6 million (53%) people had HIV in eastern and southern Africa, 5 million (13%) in central and western Africa, 6 million (15%) in Asia and the Pacific, and 2.3 million (5%) in Central and Western Europe and North America (HIV.gov, 2022). HIV is a reportable disease in all 50 states and the District of Columbia. Health providers are mandated to report new HIV infection cases to their state health departments. Most states ask for basic demographic data and HIV risk information.

Social Determinants of Health

Social determinants of health (SDOH) are major causes of health disparities in acquiring HIV and its management. Education plays a crucial role in the prevention of HIV. A high education level decreases the social and economic circumstances that increase a person’s risk for HIV. Individuals with higher education levels generally have better health outcomes since they have higher income levels and occupational status (Menza et al., 2021). According to CDC (2021), adults living in census tracts with the lowest education levels in 2019 made up the highest HIV diagnosis rates, the lowest proportion of adults receiving HIV medical care less than a month after being diagnosed, and the lowest proportion of adults with a suppressed viral load within six months of being diagnosed with HIV.

Poverty is another SDOH related to HIV. Lower-income people are at increased risk for HIV infection due to economic disadvantages that increase risky behaviors. For instance, individuals with low-income levels may engage in prostitution, increasing their risk of HIV transmission. They may not also afford protective contraceptives raising the risk of sexual transmission (Menza et al., 2021). Health insurance coverage is linked with HIV since it is associated with the utilization of HIV prevention services and better outcomes. Besides, insured persons with HIV are more likely to access HIV care and treatment, which increases viral suppression, prolongs life, and decreases mortality compared to uninsured PLWHIV (CDC, 2021). Lack of health insurance increases the risk for HIV and affects individuals’ health and well-being. According to CDC (2021), adults living in census tracts with the lowest health insurance coverage in 2019 had the highest HIV infection rates, lowest access to HIV medical care, and lowest viral suppression.

HIV Epidemiologic Triangle

The HIV epidemiologic triangle determines HIV infectivity. It includes host factors (susceptibility and infectiousness), agent factors (HIV type 1), and environmental factors (social and cultural practices). The host susceptibility is based on viral entry into cells (CD4 T lymphocytes, Langerhans’ cells, and other macrophages) via chemokine surface receptors and CD4. Host susceptibility is influenced by inflammation or immune activation factors that change the number of susceptible target cells or their receptivity (Chen et al., 2019). This can also affect virus production within infected cells, thus affecting the infectiousness of the host. The properties of HIV also influence transmission. There are various HIV subtypes with distinct geographic distributions. Subtypes A, C, D, and E are mainly in sub-Saharan Africa and Asia, and B in the US, South America, the Caribbean, and Western Europe (Govender et al., 2021). Subtype E is documented to have a higher tropism for Langerhans’ cells than B.

Environmental factors include social elements that affect infectivity, like particular sexual practices (anal-receptive intercourse), contraceptive choices, patterns of sexual partnering, and the use of substances that promote risky sexual behaviors. Besides, environmental factors affect the rate of sex-partner change, which affect the growth of HIV infections (Chen et al., 2019). Special notifications include HIV partner notification, whereby the health provider asks individuals diagnosed with HIV about their sexual partners or drug-injecting partners (Ayala et al., 2019). The provider asks for consent from the HIV-positive client to offer the partner voluntary HIV testing.

The Role of the Community Health Nurse

The community health nurse (CHN) conducts community assessments on HIV infections. The CHN collects data on the number of new and existing HIV cases in a specific community. Besides, the nurse analyzes to measure the success of the community health initiatives implemented to manage and control HIV transmission in the community. In addition, the CHN is tasked with reporting new HIV infections to the state health department. CHNs also follow up on HIV-infected persons in the community to assess treatment adherence and provide patient education on preventing transmission to others and their family members. Demographic data on HIV infection is crucial in promoting community health since it helps to monitor HIV transmission in a community and helps to know when there is an increase in new infection rates. This guides healthcare workers on the actions to take to suppress transmission rates.

National Agency that Addresses HIV

CDC is a national agency that addresses HIV in the US. CDC works with state health departments, private sector organizations, civil and faith-based organizations, and other health partners to optimize approaches for diagnosing, treating, and preventing HIV. The CDC achieves this by supporting over 10,000 labs and testing sites globally, providing life-saving treatment to PLWHIC worldwide, and designing and optimizing surveillance systems (HIV.gov, 2022). Furthermore, CDC helps other nations to recognize the geographic areas requiring urgent HIV attention and services.

Global Implication of HIV

HIV is a major global public health issue and has claimed approximately 40.1 million lives. In 2021, roughly 650 000 persons died from HIV-related causes. HIV is an epidemic that affects not only a person’s health but also households, communities, and countries development and economic growth. The epidemic has led to millions of children being orphaned, has disrupted community life, and increasingly led to the wearing down of civil order and economic growth (Govender et al., 2021). Furthermore, many countries that are worst affected by HIV also have high rates of other infectious diseases, food insecurity, and poor economic development. The HIV pandemic has significantly affected the economy, the workforce, labor costs, families, healthcare expenditures, and individuals’ savings and investments.

The HIV pandemic is being addressed in other counties through mass education programs on male and female condom use. Free HIV prevention, testing, and counseling services have been provided in hospitals. In addition, voluntary medical male circumcision has been championed to lower HIV transmission rates (HIV.gov, 2022). HIV treatment and antiretroviral therapy for HIV prevention are free in most countries. Healthcare providers in other countries are working on the elimination of mother-to-child transmission of HIV to reduce perinatal transmission.

Conclusion

HIV is caused by the human immune deficiency virus, which is spread sexually, parenterally, and perinatally. Treatment for HIV includes antiretroviral therapy to suppress viral load and prophylactic antibiotics to prevent opportunistic infections. SDOH attributed to HIV transmission include level of education, poverty level, income level, and health insurance coverage. The CHN is tasked with collecting data on HIV infections, monitoring PLWHIV, and giving information on the HIV status in the community. HIV is an epidemic whose consequences are felt by individuals, families, and countries by affecting health, quality of life, and economic growth.

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References

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Menza, T. W., Hixson, L. K., Lipira, L., & Drach, L. (2021, July). Social determinants of health and care outcomes among people with HIV in the United States. In Open Forum Infectious Diseases (Vol. 8, No. 7, p. ofab330). US: Oxford University Press. https://doi.org/10.1093/ofid/ofab330

Parekh, B. S., Ou, C. Y., Fonjungo, P. N., Kalou, M. B., Rottinghaus, E., Puren, A., Alexander, H., Hurlston Cox, M., & Nkengasong, J. N. (2018). Diagnosis of Human Immunodeficiency Virus Infection. Clinical microbiology reviews, 32(1), e00064-18. https://doi.org/10.1128/CMR.00064-18