Public Health and HIV and AIDS

Figure 7.  Percentages taken from the HIV section of the YBRFSS from 1991-2017 of High School Students across the United States

Note. Taken from the Youth Risk Behavioral Survey. (2017). Trends in the prevalence of sexual behaviors and hiv testing national yrbs: 19912017. Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2017_sexual_trend_yrbs.pdf

According to the YBRFSS (2017) taken earlier this year, nationwide 39.5% of high school students had participated in sexual activity with someone of either sex or both during their lifetime, 9.7% had four or more sexual partners, and 28.7% of these students had had sex three months before this survey was taken.  Shockingly enough 53.8% reported that either they or their partner had used a condom during sex, which means a little less than half are engaing in unprotected sex (YBRFSS, 2017).  In another self reported survey only 9.3% of these high school student shad ever been tested for HIV.  This data is reported in the table that follows.

Figure 8.  Percentages taken from the HIV section of the YBRFSS from 1991-2017 of High School Students across the United States

Note. Taken from the Youth Risk Behavioral Survey. (2017). Trends in the prevalence of sexual behaviors and hiv testing national yrbs: 19912017. Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2017_sexual_trend_yrbs.pdf

Assuming this data is accurate the adolescent youth in the U.S. are at major risk for developing HIV and other related sexually transmitted diseases. This stems from the lack of information about unsafe sex practices and lack of access to contraceptives and knowledge of how to use them.  Better practices must be implemented in the school setting in regards to informing students about various forms of STDs, as knowledge is power. Providing and arming our youth with this information is the first step both health professionals, schools, and communities can take in prevention of HIV.

BRFSS HIV Data: Guam vs. United States

        When comparing self-reported screening data for HIV provided by the Behavioral Risk Factor Surveillance System (BRFSS) about the U.S. and Guam, the results appear to be very similar.

Table 2.  Percentage in the U.S. and D.C. tested for HIV (2013-2017)

Note. Retrieved from Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health: BRFSS Prevalence & Trends Data

Table 3.  Percentage in Guam tested for HIV (Crude Rate: 2013-2017)

Note. Retrieved from Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health: BRFSS Prevalence & Trends Data

As the tables above show, people in the United States and Guam were asked if they were ever tested for HIV from the years 2013 to 2017.  Table 3's data shows that although Guam was near the average percentage of the U.S., they fell below average for those who confirmed screening up until last year (BRFSS, 2017).  However, this data may be misleading, as the sample size for this year was only 857 people, which was not as large and consistent with the previous years (sample size being over 1000).  As this indicates a low response by individuals in the Guam community there might be a lack of awareness of the current situation in regards to STDs here on island.  With that being said, Guam is in no better state of prevention or screening methods and must also enact better policies and laws in the community to increase the percentage of people seeking to be screened.

Action Plan Policies and Laws

Identifying At-Risk Populations

As with any disease it is important to identify those who are most at-risk for developing the disease itself and providing screening and treatment options during its earliest stages.  Everyone is at risk for developing these two viruses however the rates are shown to be more prevalent in those who participate more frequently in unprotected sex and with multiple partners.  These two subgroups are primarily young African American and Latino men, affiliated with the LGBTQ+ community and high school students (CDC, 2017).  Current rates also tend to be higher of course in denser populations in the United States as shown in Figure 6 below:

Figure 6.  Rates of HIV Diagnoses Among Adults and Adolescents in the US by State, 2016

Note. Graph taken from the CDC. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report2017;28.

States like Georgia, Florida, Maryland (DC), Louisiana, and Nevada are known to have denser populations, thus the reason for rates of 20.0 and greater per 100,000 people of HIV diagnoses.  Although California and Texas are known to have the highest populations in the U.S., what these two states lack is a higher homosexual rate per person than the previously mentioned five.  According to a news article from the New York Times titled The Metro Areas With the Largest and Smallest, Gay Populations, New Orleans, Atlanta, Jacksonville, District of Columbia, and Las Vegas have the highest homosexual populations in the nation, Atlanta being known as the gay capital (Leonhardt, 2015).  This signifies why Georgia has the most incidences of HIV in the country.  To further this, the CDC also stratified its HIV surveillance population by gender and sexual orientation in Figure 2 and by ethnicity and region in Figure 3 as shown below:

Figure 7.  New HIV Diagnoses in the United States for the Most-Affected Subpopulations, 2016

Note.  Subpopulations representing 2% or less of all people who received an HIV diagnosis in 2016 are not represented in this chart.  Graph taken from the CDC. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report2017;28.

Figure 8.  New Diagnoses in the US by Race/Ethnicity and Region of Residence, 2016

Note. Graph taken from the CDC. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report2017;28.

When comparing Figure 7 and 8 there are evidently higher rates of new HIV diagnoses in the African American and Latino populations when compared to Caucasians.  Furthermore evidence shows that homosexual males especially of those two minority subgroups are the most affected for HIV diagnosis in 2016.  These trends have remained unchanged since 2016, sparking a revolution in labeling these minority subgroup populations, as a priority when developing prevention and treatment plans.

Current Prevention and Treatment Options

Unfortunately there is no known cure at the moment for HIV or AIDS, but treatment does exist.  Those diagnosed with HIV or AIDS are prescribed antiretroviral therapy also known as ART.  According to the World Health Organization (WHO) (2018), standard antiretroviral therapy consists of the combination of ARV drugs to maximally suppress the HIV virus and stop the progression of HIV disease.  So it is safe to say that those who seek and adhere to treatment regularly can maintain and live a normal lifestyle.  Another beneficial side effect of ART is that HIV can no longer be transmitted from the person undergoing treatment to someone else.  Along with treatment, prevention of obtaining HIV has also been successful, as pre-exposure prophylaxis (PrEP) has been shown to reduce acquisition of this disease among people who are at substantial risk by 92% (HP2020, 2018).  Safe sex practices such as using condoms, having only one sexual partner, and remaining obstinate have also proven to be effective methods in preventing HIV and other sexually transmitted diseases. By careful planning and mobilization of prevention and treatment forces, it is the hope of many world renown health organizations like, WHO, and the CDC, to one day stop the spread of HIV and AIDS and find the cure, eradicating the disease.

Lawmakers have created many policies implemented in the hospital setting to ensure the prevention of HIV and AIDS.  In reference to a Health Research & Education Trust (HRET) (2005) pamphlet, HRET conducted a national survey where they recorded that 91% of U.S. hospitals offer HIV tests in their facilities.  When a patient is screened for HIV and their test comes back positive they are immediately notified about their status and are asked immediately to come in to be examined and start treatment with their corresponding symptoms.  Counseling programs are offered to help patients understand the severity of their situation and allow them to cope emotionally and mentally if needed.  Their diagnoses are then input to a database confidentially and they are then asked to report those who they have had recent sexual encounters with as far back as they can recall.  This process takes time but has proven to be effective.  ART is then administered to patients to help with suppressing the disease so transmission is negated.  However, that is only half the battle.  What is prosing the biggest threat to our community is fighting these infectious diseases outside the hospital environment.  To combat this the Department of Public Health and Social Services (DPHSS) located here on Guam provides services like, HIV/STD counseling, testing, and referral, prevention for positives, partner services, condom distribution, and health education risk reduction and public information campaign known as Prutehi Hao' or Protect Yourself' (DPHSS, 2018).  The previously mentioned public health organizations mission is to reduce the number of incidences of STD/HIV infection throughout the island, but that can only happen when both health officials and the community work together hand in hand to resolve this pressing issue.

        As mentioned before a lot of the at-risk populations for developing HIV, are young high school students and gay or bisexual men.  Prevention programs need to be aimed at targeting this population in hopes to decrease new incidences of this disease. According to a systematic review and meta-analysis, School Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis, it stated that school based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly great HIV knowledge, self-efficacy related to refusing sex or condom use, fewer sexual partners and less initiation of first sex during follow up. This study proves that once the youth is educated they tend to make better decisions for themselves when engaging in sexual behaviors.  On Guam, the Guam Department of Education (GDOE) released an HIV Prevention Progress Report back in 2011 listing a variety of goals educators and guidance counselor's grades K-12 must reach by 2012.  One of the listed goals that were met was attending the 2011 National HIV Prevention Conference.  Unfortunately, a recent article labeled Curriculum authors: Teach sex education personal well being through culture, from the Pacific Daily News (PDN) argues that GDOE has failed to use and implement this training.  In 2017, PDN covered a sexual education and health panel at the University of Guam and quoted sex education researcher, Francine Naputi.  Naputi (2017) states that, Guam public schools' lack sex education classes, though there is a parenting course, and then poses the question, Why do we only talk to our kids when they're pregnant or get infected?   Naputi argues that GDOE only tends to get involved during the treatment process, rather than trying to prevent the problem in the first place, which is too little too late.

Now focusing on the other half of the at risk population, males identifying as gay or bisexual, also have an increased risk for contracting HIV.  This reason is partly due to the fact of a poor supportive environment.  According to the CDC (2018) in 2014, only 38% of schools had a gay/straight alliance program, 35% of schools provided services specifically for gay, lesbian, or bisexual students, and only 35% taught how to correctly use a condom.  Assessing these rates only about one third of schools nation wide provide supportive environments for the LGBTQ+ community and knowledge of condom usage.  The need for knowledge of how to properly use a condom is especially important for young teens and adults because many believe that condoms are primarily used to avoid pregnancies.  Since homosexual relationships involve same-sex partners the chances of a pregnancy is zero, so the belief that a condom is not needed is popular.  Condoms are an effective method for preventing STDs and HIV transmission among the sexually active and need to be encouraged especially at the high school level where risky behaviors seem to occur the most.

World AIDS Awareness Day

HIV and AIDS is not only a problem in the United States, unfortunately it is a global occurrence.  Countries around the world have come to a consensus that this virus is a concern that needs to be eradicated.  To ensure this, people globally have banded together to inform and empower those all over the world to take matters into their own hands by branding the first day of December as World AIDS Day.  Signifying a red ribbon as their symbol for their movement, the World AIDS Day campaign use this as a way to, signify awareness and support for people living with HIV (2018).  Here in the U.S. the campaign targets high schools, colleges, workplaces, and communities throughout the nation to promote AIDS awareness and raise funds to help procure money for continued treatment and research.  In the end it is the hope of the campaign to eventually find a cure for those currently suffering from HIV and AIDS and to ensure that this virus can no longer affect anyone else in the future.

Resolution

As stated previously, the alternative method of prevention through treatment using PREP has shown to decrease the chances of contracting these two viruses.  In addition to, current treatment regimens of HIV and AIDS with ART have been proven to show effective results in reducing transmission from person to person. Those who are receiving treatment are able to maintain their daily life routines as long as they adhere to treatment protocols.  The main problem behind why transmission of HIV occurs today is due to lack of sexual education and supportive environments in schools, cultural and social barriers, adherence to treatment, and access to and availability of screening and treatment facilities.  This is where the community needs to work with public health officials to ensure that everyone is knowledgeable of what HIV is, how to prevent it, and how to seek care.  Starting at the high school level, GDOE should start implement sexual education material into their health classes' curriculum.  Counselors should show openness to students of any and all sexual orientations about sexual intercourse and provide condoms for use in their offices.  School nurses should partner and train with public health officials to learn how to handle STD and HIV related cases in students.  DPHSS as of right now does their best to provide screening services to a variety of populations here on Guam, but at best their efforts are mediocre due to poor community collaboration.  This poor collaboration could stem from the fact that sexual intercourse has been seen in a negative light, depicting promiscuous behavior in many cultures and religions.  Rather than shame those who participate in these behaviors the government of Guam should work together with DPHSS to encourage and foster a positive environment for those who fear they might be suffering from any sort of STD to seek treatment.  This positivity is definitely needed since Guam has one of the highest rates of Chlamydia in the nation.  Lastly, to ensure adherence to treatment of HIV and AIDS strict protocols should be enforced to ensure patient cooperation.  If the patient abuses their privilege by taking other illegal drugs or using alcohol while on ART, there must be a penalty of some sort like increased health insurance.

Conclusion

Public health officials and organizations across the globe have reached monumental strides in the prevention of transmission and treatment of HIV and AIDS since its discovery in the 1980s.   Although transmission still occurs today, as long as health officials continue to reevaluate their approach on how to react to preventing and treating HIV and AIDS, these diseases can become a thing of the past.  Sexual education targeted towards highly at-risk populations like high school students and homosexual and bisexual males, proper training of health officials administering treatment and counseling, and better access to medical care and stricter protocols for treatment are needed to reach future goals set by those at the Healthy People organization.

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