Effects that Plague the U.S. and Guam Communities

Human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) has been a recurring issue around the world.  Since HIV remains an incurable infectious disease, prevention and treatment are crucial to many healthcare professionals, organizations, and communities globally.  Although there has been a slight decline in the number of cases of HIV and AIDS in the past year, transmission of this disease still plague the United States and the island of Guam.  This paper will examine several root causes and effects of these two diseases, provide statistical evidence that demonstrate the severity of the current situation and at risk populations, and analyze and suggest several improvements to current laws and policies in place that affect and influence the health decisions made by people today.

Key Words: human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS)

HIV and AIDS:

Examining the Effects that Plague the U.S. and Guam Communities Today

Introduction

It is common knowledge that the human body is prone to several diseases, infections, and dysfunctions that can hinder the quality of life, so it important to treat our bodies with the utmost respect.  While not all diseases and infections can be avoided due to genetic predispositions and other factors, there remain numerous of diseases and infections that can actually be prevented in taking proper precautions during our daily routines.  One of these easily preventable infectious diseases is the human immunodeficiency virus, widely known as HIV.  Another easily preventable disease commonly associated with HIV is the acquired immune deficiency syndrome, abbreviated as AIDS.  AIDS is considerably one of the most dangerous infectious diseases that are still prevalent today.  Although transmission of these diseases have decreased by 18%, due to the lack of information about precautionary measures pertaining to sexual intercourse, sexual education in schools, and access to preventive care and treatment, HIV and AIDS continue to plague the human population on a global scale.

Human Immunodeficiency Virus

According to a national newsletter released by the National Institute of Health (NIH) (2015), which is a part of the United States Department of Health and Human Services, HIV is a virus that harms your immune system by invading and then destroying your infection-fighting white blood cells.  This virus infiltrates these white blood cells altering its normal functions; what was once our greatest protection against outside bacteria is now our own worst enemy.  Seemingly harmless illnesses, such as the common cold, is now just as life threatening as the flu or pneumonia.  HIV transmission is passed through the exchange of bodily fluids, such as blood and semen, from one infected person to the next.  Ninety percent of the time HIV is transferred during sexual intercourse that includes vaginal, anal, and oral.  The second most common route is injection through used needles, and lastly the transmission of the illness from mother to fetus or through blood transfusions (NIH, 2015). The nonchalance of disregarding protection during sex and the sharing of needles during drug use are two major reasons why HIV and AIDS remains a nuisance to our society.  MedLine Plus (2015) states that, the first signs of HIV infection may be swollen glands and flu-like symptoms, that may come and go within two to four weeks. This is important to note because HIV may not present itself as evident in its host making a lot of people disregard the severity of their situation.  After this two to four week incubation period symptoms of HIV go dormant leaving the host unsuspected that they are now a carrier of the disease.  It will not be until months after does the carrier know they are infected. 

This causes a vicious cycle where the infected person unknowingly may spread the disease to someone else or multiple others, which then in turn causes those who are newly infected to then transmit, HIV to another person.  The Healthy People 2020 or HP2020 (2018) website provides evidence of this cycle in stating that an estimated 1.2 million American are living with HIV, and one out of eight people are unaware of their status.  This argument is then furthered by a statistic showing that ninety-one percent of new HIV infections in the United States are transmitted from people not diagnosed or diagnosed and not in care.  The need for better informative procedures about this disease is in dire need by educators and health professionals.  HIV is broken down into four stages according to the Center for Disease Control (CDC) (2014): stages zero, one, two, and three.  Stage zero is the first initial positive test six months after screening.  From there the stage level of HIV is then reevaluated and determined based on the longevity and symptoms present in the individual.  If the patient receives a diagnosis of stage three HIV, the disease has progressed to AIDS.

Acquired Immune Deficiency Syndrome

AIDS was first discovered during the early 1980's and was first believed to only be associated with the homosexual male community.  This belief coined the term gay-related immune deficiency (GRID) for a couple months until further evidence suggested that not only gay men could contract the disease.  At this time the incidence of AIDS began to be reported worldwide, specifically in regions of Europe and Africa.  According to the Mayo Clinic (2015) website, the CD4 T cells, also known as your white blood cells, that were infected during the earlier stages of HIV now begin to die off, severely weakening the immune system leaving the body defenseless.  Once the individuals white blood cell count drops below two hundred they are deemed stage three of HIV or AIDS.  Again, this emphasizes the importance of education and early detection and screening about these types of diseases.  This process typically takes about ten years before HIV evolves into AIDS.  Signs and symptoms are more severe and include: recurring fever, chronic diarrhea, unusual lesions on your tongue or in your mouth, persistent and unexplained fatigue, weight loss, and skin rashes or bumps (Mayo Clinic, 2015) just to name a few.  Those who suffer from AIDS are now more susceptible to various forms of cancers and infections that would not trouble a normal person.  Some common infections that are associated with AIDS would be tuberculosis, Cryptococci meningitis, and candidiasis.  Cancers commonly affiliated with these diseases are Kaposi's sarcoma and lymphoma.  These previously listed infections and cancers are among the leading causes of death in patients diagnosed with HIV and AIDS. There is a misconception that AIDS is a different virus than HIV so transmission of this virus differs, but as mentioned recently AIDS is just a severer form of HIV.  Since AIDS is the last stage of HIV, transmission is virtually the same. Some are misinformed believing that these two diseases can be spread through ordinary contact like hugging, kissing, sharing drinks, or through the air.  This belief can sometimes instill fear of rejection in patients diagnosed with HIV and AIDS causing them not to disclose their own diagnosed status with current and future sexual partners.  People may even go as far as concealing their symptoms from their current physician and possible refuse to seek treatment due to embarrassment.

Mission and Objectives HP2020

The HP2020 (2018) website states that its overall goal is to, prevent human immunodeficiency virus (HIV) infection and related illness and death. The website has also laid out three primary objectives that healthcare professionals and organizations should strive to reach.  These three primary objectives are: reducing new HIV infections, increasing HIV testing and prevent HIV risk, and increasing access to care and improving health outcomes for people living with HIV.  Under each of these primary objectives are subcategories that pertain to each objective.  There are a total of twenty-three sub goals that each provide data like tables and graphs that show the progress that has been made since the mid 2000's.  As stated before an estimated 1.2 million people are living with HIV.  Among these 1.2 million one out of eight people are unaware of their infected status.  HP2020 also reports that the annual infection rate has actually declined by 18% here in the United States from 2008 to 2014.  Despite this significant decrease in that six-year times span this disease continues to spread. 

HP2020 Objective: HIV-1

One of the objectives HP2020 has set up to help with achieving their goal by the year 2020 is to reduce the number (number, all ages) of new HIV diagnoses.  The following graph accounts for the number of diagnoses from 2010 to 2015:

Figure 4.  New HIV diagnoses (number, all ages) By Total

Note. Graph taken from the HP2020 website displaying goal for newly HIV diagnosed patients in the U.S. Human Immunodeficiency Virus (HIV). (n.d.). Retrieved October 20, 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/hiv

According to Figure 1, the data demonstrates that there has been a steady decrease in newly diagnosed HIV patients within the U.S. from 2010 to 2015.  At the beginning of 2010 there was a baseline of 43, 806 new incidences of HIV by 2015 the number had decreased marginally to 40,040 (HP2020, 2018).  Unfortunately the goal that Healthy People set out to reach by the year 2020 is 32,855 new incidences, which at this rate seems unlikely to be fulfilled.

HP2020 Objective: HIV-9

A second objective that HP2020 has set to achieve surrounding the AIDS epidemic currently plaguing the U.S. is to, reduce the proportion of persons with a diagnosis of Stage 3 HIV (AIDS) within three months of diagnosis of HIV infection (HP2020, 2018).  Figure 2 below was also taken from the HP2020 website illustrating the percentage of people who have contracted AIDS after 3 months of HIV infection:

Figure 5.  Persons with a diagnosis of AIDS within 3 months of diagnosis of HIV infection (percent, 13+ years) By Total

Note. Graph taken from the HP2020 website displaying goal for newly AIDS diagnosed patients in the U.S. Human Immunodeficiency Virus (HIV). (n.d.). Retrieved October 20, 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/hiv

Again a baseline is provided and a target goal for 2020 is shown.  Starting in 2008 it was estimated that 25.9% of people were reaching stage three of HIV within the first three months of their diagnosis.  Six years later this rate had steadily declined to only 23.1% in people thirteen years and older (HP 2020, 2018).  If this decline continues at this rate by 2020 the possibility of reaching this goal and even surpassing it seems very hopeful.

        When comparing these two subsets of data it is evident that treatment, like ART, has had more success in moving towards its goal than new incidences of HIV cases.  With that being said, efforts towards prevention still need to be revised and executed more effectively.  In order for health officials, organizations, and the community itself to improve prevention efforts it is important to understand the root cause of the problem, in this case we must ask ourselves, Why is HIV still being spread despite current health regulations and precautions?  If we are able to answer this question then our focus can shift primarily to prevention methods, which will then in turn eliminate the costs of treatment and relieve the burden of financial restrictions both on the patient and the health care industry.

Health Determinants Root Causes

As with any problem we must understand what is causing it in the first place.  Transmission of HIV is the problem in this case and we must determine why it is still prevalent after so many steps have been taken towards prevention. 

Figure 6.  Root Cause Analysis of HIV and AIDS Transmission

Note. Statistics obtained from the Healthy People 2020 website. Retrieved October 20, 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/hiv

The root cause analysis depicted above in Figure 6 documents three main causes behind the reason why transmission of HIV is still a problem today despite statistical evidence showing a decrease over recent years. 

Fear of Judgment and Failure of Adherence

The first two causes state that fear of being judged by health practioneers and friends and family about one's sexual endeavours can make them refrain from seeking screening or treatment and those that do some of them suffer from substance abuse and other personal daily obligations that hinder adhereance to treatment.  Disclosing personal information like sexual acitivity can be very hard for most people especially those who are underage fearing their parents may find out.  Reputations are important to many and being open about matters like an HIV infected status or having mutlple sexual partners can be scary as it may write them off as dirty, untouchable, or someone who likes to sleep around.  However those whoe seek treatment tend to also add to the problem of transmission.  In a study titled, Factors Affecting Adherence to Antiretorviral Therapy, done by Margaret Chesney (2000) from the Univeristy of  California San Francisco's School of Medicine, she reports that nonadherence to antiretorviral therapy range from 50% to 70%.  She also states that, principle factors associated with nonadhearance appear to be patient-related, the major factor included substance and alcohol abuse  (Chesney, 2000).  As with any prescription drug that needs to be taken daily, mixture of alcohol or other drugs is highly cautioned against.  Those who were undergoing ART during this study and were drug abusers tended to place their cravings before their personal health.  Putting themselves in a position to spread HIV to others.  Other patient-related nonadherences can be found in the following the table:

Table 1.  Frequent causes for medication nonadherence by HIV-infected patients who are receiving highly active antiretroviral therapy.

Note.  Adapted from Chesney, MA. (2000). Factors affecting adherence to antiretroviral therapy. Clinical Infectious Diseases, 30(Suppl 2), S171-S173. Retrieved from https://academic.oup.com/cid/article-abstract/30/Supplement_2/S171/373130

By analyzing the table above many patients reported that the obstacles in life, like work, school, and family orietnated activities proved to intefere to a point that consistently taking their medication was not manageable.  Other emotional and physical side effects also contributed to the reduction of adherance to self medication.

Sexual Education in High Schools

The second cause relates to the lack of sexual education or information about practicing safe sex to high school students.  As mentioned previously the data taken from the HP2020 website includes ages thirteen years and up, meaning that high school students are also at risk for contracting HIV and potentially developing AIDS.  It is common knowledge that during teenage years to early adulthood the willingness to adventure and explore one's sexuality is at its all time high.  The following table was taken from the CDC's 2017 Youth Behavioral Risk Factoe Survlliance Survey (YBRFSS):

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