HIV Overview, Objectives and Interventions
HIV Overview, Objectives and Interventions
Healthy People is a nationwide health-promotion and disease-prevention program that has goals set by the United States Department of Health and Human Services. A topic of major concern in the Healthy People 2020 program is the human immunodeficiency virus (HIV) epidemic. HIV is a slowly replicating retrovirus that causes acquired immunodeficiency syndrome (AIDS), a condition which causes progressive failure of the immune system thus allowing deadly opportunistic infections and cancers to flourish (Gilbert et al., 2007). Infection with HIV occurs by the transfer bodily fluids such as blood, semen, vaginal fluid, pre-ejaculate, or breast milk (Dieffenbach & Fauci, 2011). The Healthy People 2020 HIV programs strategy is broken down to 3 primary goals with the overall objective to prevent HIV infection and its related illness and death.
The history of HIV and AIDS is a relatively recent one. Researchers believe is has been around since the 1960's through the 70's but not diagnosed due to small numbers and insignificant signs or symptoms of the disease (Gilbert et al., 2007). The HIV/AIDS pandemic started in the mid to late 1970's and by 1980 the still unknown virus had spread to Europe, Africa, Australia, North America and South America (Dieffenbach & Fauci, 2011). The first signs of a new disease started in 1981, when the rare diseases kaposis sarcoma and pneumocyctis carinii pneumonia were being diagnosed in young, homosexual men in the United States. The causes of these opportunistic infections and cancers were unknown but it was thought to be a new contagious disease only spread in gay men and injection drug users (Chang, Bowman, Weiss, Garcia, & White, 1993). By July 1982, a total of 452 cases from 23 states of the previously rare pneumocyctis carinii pneumonia were reported to the Centers for Disease Control and Prevention. The end of 1982 the disease was named Acquired immune deficiency syndrome or AIDS (Dieffenbach & Fauci, 2011). During this time, there was much fear and prejudice about the disease, the people infected by the disease and the overall population of people that the majority of infections were being diagnosed.
Much research went into finding the cause behind this new disease. In France, doctors at the Institute Pasteur isolated a virus which they thought may be the cause of AIDS. They named the virus lymphadenopathy-associated virus or LAV (Dieffenbach & Fauci, 2011). Almost a year later, in 1984, the United States Health and Human Services Secretary Margaret Heckler announced that Dr. Robert Gallo of the National Cancer Institute had isolated the virus which caused AIDS and that it was named HTLV-III. It took another year to determine that LAV and HTLV-III were, in fact, the same virus and another year before the HIV name was universally adopted for the virus in 1986 (Chang et al., 1993). Spreading rapidly, AIDS was reported in every region in the world by the end of 1985 and by the end of 1986 a total of 85 countries had reported 38,401 cases of AIDS to the World Health Organization. The totals by region were Africa 2,323, Americas 31,741, Asia 84, Europe 3,858, and Oceania 395 (Dieffenbach & Fauci, 2011).
Much has been done in the last decade with effective treatment to decrease the number of HIV infected individuals that progress to AIDS. People infected with HIV are living longer, healthier, and more productive lives. Due to this, public perception in the United States about the seriousness of the HIV epidemic has declined in recent years and there is evidence that behaviors increasing the risk for infection may be increasing among certain populations (Lert, 2000).
At the end of 2011, 34.2 million people world-wide were living with HIV. That same year, some 2.5 million people became newly infected with HIV, and 1.7 million died of AIDS. More than two-thirds of new HIV infections are in sub-Saharan Africa (UNAIDS, 2012). The United States has an estimated 1.1 million persons living with a diagnosed HIV infection with 487,692 persons living with an AIDS diagnosis (Centers for Disease Control and Prevention [CDC], 2011). On a state level, Utah new HIV Infection rates have increased 7% from 2010 to 2011; while decreasing 26% from 2007 to 2011. People living with a HIV infection had a rate increase of 2.2% from 2010 to 2011. Utah has a total of 2,614 persons living with HIV with 94 of those newly diagnosed in 2011 (Utah Department of Health, 2011). Davis county has a low rate in the state considering the it is the third most populated county in the state. In 2011, of the total reported sexually transmitted diseases in the county, 1% were HIV infections. (http://daviscountyutah.gov/health/communicable_disease/epidemiology/std_hiv_statistics.cfm). The World, the United States and Utah all have more people living with HIV than people living with AIDS but in Davis County the last available totals showed almost double the people living with AIDS then living with HIV. In 2009, the total people in the county living with HIV is 53 and 109 living with AIDS (Utah Department of Health, 2011).
The future goals of prevention are reducing the number of people who become infected with HIV, for improved access to care and health outcomes for those living with HIV and reducing related health disparities of HIV (http://www.healthypeople.gov). With a growing number of people living with HIV, it is important to increase HIV prevention and health care programs. There are gender, race, and ethnicity disparities in new HIV infections. Nearly 75 percent of new HIV infections occur in men, more than half of which are in gay and bisexual men. Racial disparities include 45 percent of new HIV infections occur in African Americans, 35 percent in whites, and 17 percent in Hispanics (Hall et al., 2008). Improving access to health care for these populations that are disproportionately affected by HIV is a primary public health strategy for HIV prevention.
Reduced infection rates have been seen with effective HIV prevention interventions. Education on routine HIV testing and prevention and protection methods are an important role nurses play in the prevention of HIV. It is estimated that 21 percent of people who have HIV do not know it, and that they then pass it on to more than half of the people with a new HIV diagnosis (CDC, 2011). Consequently, testing is important so that infected individuals can modify their behavior improve their health and reduce the risk of transmitting HIV to their partners.
As the number of people living with HIV increases, it is essential to promote wider availability of comprehensive services for people living with HIV and their families. Through partnerships with community organizations, health department programs, local support groups and social service providers people infected with HIV can get the help and support they need to receive needed antiretroviral therapy, screening and treatment for other sexually transmitted infections, HIV prevention interventions and mental health services (Dieffenbach & Fauci, 2011). Support groups can also help people living with HIV focus on linking to and staying in treatment, increasing HIV prevention interventions for both them and their partners and improve their state of well-being.
Centers for Disease Control and Prevention. (2011). Diagnoses of HIV infection and AIDS in the United States and dependent areas, 2010. Retrieved from http://www.cdc.gov/hiv/surveillance/resources/reports/2010report/index.htm
Chang, S. P., Bowman, B. H., Weiss, J. B., Garcia, R. E., & White, T. J. (1993, June 3). The origin of HIV-1 isolate HTLV-IIIB. Nature, 363, 466-469. http://dx.doi.org/doi:10.1038/363466a0
Dieffenbach, C. W., & Fauci, A. S. (2011, June). Thirty years of HIV and AIDS: future challenges and opportunities. Annals of Internal Medicine, 154(11), 766-771.
Gilbert, T. P., Rambaut, A., Wlasiuk, G., Spira, T., Pitchenik, A. E., & Worobey, M. (2007, September). The emergence of HIV/AIDS in the Americas and beyond. Proceedings of the National Academy of Sciences of the United States of America, 104(47). http://dx.doi.org/doi:10.1073/pnas.0705329104
Hall, H. I., Song, R., Rhodes, P., Prejean, J., An, Q., Lee, L. M., ... Janssen, R. S. (2008). Estimation of HIV incidence in the United States. The Journal of the American Medical Association, 300(5), 520-529.
Lert, F. (2000, December). Advances in HIV treatment and prevention: should treatment optimism lead to prevention pessimism? AIDS Care, 12(6), 745-755. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11177454
UNAIDS. (2012). UNAIDS world AIDS day report 2012. Retrieved from http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/JC2434_WorldAIDSday_results_en.pdf
Utah Department of Health. (2011). 2011 HIV/AIDS highlights in Utah. Retrieved from http://health.utah.gov/cdc/hivsurveillance/hiv%20docs/2011%20Utah%20HIV%20Highlights.pdf