Controlling Emerging Diseases: HIV

Abstract

HIV is a common environmental issue affecting people globally. It has raised the alarm on how we should abstain from being influenced, creating a sense of realization in the community. With its tremendous effect worldwide, government agencies and non-governmental organizations are working on how to help the afflicted, for example, by providing out with antiretroviral therapy for free or, in some instances, at a lower price.¹ This slackens the virus from procreating and helps fight minor diseases.

Introduction

HIV (Human Immunodeficiency Virus) is a disease that affects the human immune system and weakens the body’s defense against other diseases. Without treatment, HIV leads to AIDS (Acquired Immunodeficiency Syndrome). HIV has no cure but with proper treatment, HIV can be controlled. With 40 million people affected with this disease between 1990-2021, it has raised several concerns about how people should abstain from being influenced. This has created public awareness in the community and the education center, where students are guided on abstaining.

Background

Origin of HIV:

Scientists reckon that between 1884-1920 HIV was first transmitted in Western and Central Africa, where Africans practiced hunting and gathering chimpanzees. While consuming the chimpanzee’s meat, scientists believe that the simian immunodeficiency virus (SIV) jumped into humans and mutated into what we acknowledge as HIV.⁴ Investigators appraise that by 1980 the strains of the virus began spreading across the other parts of the world. Urbanization, long-distance trade, changing sexual mores, and drug abuse are the major factors that led to the worldwide spread of the virus.

Agents of HIV:

The primary hosts for HIV are the white blood cells, also known as CD4+ T cells, helper T cells, or helper T lymphocytes. These cells are crucial in triggering the responses of numerous other immune cells in the immune system. Helper T cells that contract HIV promptly die. After primary infection, the body can typically replace lost infected helper T cells by bringing out more of them when HIV patients become asymptomatic. Steadily as time passes, the virus worsens, and the number of helper T cells gradually decreases.

Transmission pathways of HIV:

HIV is spread directly from an infected person to an uninfected person by exchanging body fluids such as blood and blood products, semen, other genital secretions, or breast milk. The main method of transmission on a global scale is through sexual contact with an infected individual. Intravenous drug users who share needles or syringes frequently contract HIV. When prescribed immediately upon diagnosis, antiretroviral therapy can minimize the risk of transmission from infected persons to their uninfected sexual partners by about 96 percent.

Moreover, long-term antiretroviral medication adherence can lead to an undetectable HIV viral load, which renders the virus incapable of being transmitted through sex. This phenomenon is known as “undetectable = untransmittable” (U = U). Coughing, sneezing, or casual contact do not spread HIV. HIV is weak and hence cannot endure long periods outside the body. Thus, the direct transfer of body fluids is essential for transmission. Other sexually transmitted illnesses such as syphilis, gonorrhea, and chlamydia enhance the chance of obtaining HIV through sexual intercourse, possibly through the genital sores they cause.

Past policies and practices:

Many preventative measures have been shown to reduce the spread of the human immunodeficiency virus (HIV). Over the past three decades, researchers discovered effective therapies to control the illness and various methods to lower the risk of contracting HIV and stop the disease from progressing to an AIDS diagnosis.² Resources necessary to halt the epidemic were invented. However, it remains difficult to execute these measures successfully as HIV infection rates are still rising worldwide. Professionals in public health concur that using just one technique will not be successful. The following are different policies that were implemented

• Harm reduction strategy

Sharing needles and drug paraphernalia is still a significant source of HIV infection, especially in Central Asia and the Russian Federation, even though many other areas are declining. Programs for exchanging used needles are an indirect tactic. To decrease the supply of contaminated needles and syringes circulating in communities, needle exchange programs issue clean needles and syringes and collect dirty ones. They typically offer education about the importance of not sharing the sterile needles and syringes they receive. Nonetheless, getting comprehensive coverage in the community is crucial to the effectiveness of these programs.

Drug users who are engaged in drug rehabilitation centers can have their urine routinely tested for the presence of narcotics. This tactic has been nicknamed “pay for a pee” by some. Negative pee tests earn them money. As long as clean urine samples are provided, these rewards often rise. However, a positive pee test stops the growth of these financial incentives and sends the user back to the start of the payment schedule. Although this approach works for drug addicts in recovery centers, it is less confident whether it will work for the entire community of drug users.

• Testing

Many people are apprehensive about being tested. Many tactics have been created to overcome this resistance. The initial tactic was letting people submit to anonymous testing at designated testing facilities, with the understanding that if they discovered they were sick, they would seek medical attention. Self-testing is now possible because of the test’s administration’s simplification. Innovative tactics, like vending kiosks that sell home testing kits, have been used in several nations. Once more, it is assumed that people who test positive will seek medical attention.

• Prevalence of same sex

In the last five years, the prevalence of HIV among males who have sex with men has multiplied tenfold in the Philippines. Effective HIV prevention strategies receive no national education, and regulations forbid minors under 18 from receiving HIV tests without parental agreement or having access to condoms. These elements are part of the epidemic of adolescent males engaging in same-sex behavior, which is worsening. Although the Philippine government implemented robust measures to combat the HIV epidemic among commercial sex workers in the 1990s, it has failed to modify its preventative tactics to consider the epidemic’s shifting epicenter.

Besides the fact that men who have sex with other men account for 81 percent of all HIV diagnoses since 1984, according to the Department of Health records, the government has not specifically targeted HIV prevention efforts at this group. The Philippine government has failed to offer comprehensive education programs on safe sex practices despite national legislation requiring compulsory sex education.³ As a result, the country faces difficulties in dealing with HIV, leading to an increased transmission rate.

Guidelines:

The 1989 International Consultation on AIDS and Human Rights, jointly convened by the then United Nations Centre, was the first gathering to examine the development of such guidelines. The need for a deeper explanation of how current human rights concepts apply to HIV and for examples of specific actions that States should take to defend human rights and public health in HIV became increasingly apparent to the international community.⁶ The following methods were carried out and recorded according to my investigation of three different states, Thailand, Poland, and Spain.

• Access to testing

Provider-initiated testing, counseling, and free testing services were among the policy indicators expressly or partially followed in the three countries. While Thailand and Spain did not specify the high-risk groups, Poland was the only nation without a policy aimed at testing among high-risk populations. Both countries had rules that specifically allowed children to obtain testing without parental permission.

Several WHO (World Health Organization) materials emphasized confidentially and equality but did not provide precise instructions on protecting anonymity. These countries had regulations that set a cap on how many testing sessions counselors may conduct each day. Numerous WHO publications emphasized confidentiality and equality but did not provide precise instructions on protecting anonymity.

• Access to care and treatment

Amidst WHO documents only implying free public sector access through the promotion of universal access to HIV services, free public sector access to PMTCT and ART was universally guaranteed, either explicitly in HIV policies, implicitly in national health policies, or stated in the national constitution.⁴ All nations encouraged using PMTCT during prenatal care, and all permitted clinical officers, medical assistants, or nurses to initiate ART.

The requirement for CD4+ T-lymphocyte (CD4+ cells) testing at least every six months in the pre-ART phase and for all recorded pre-ART visits in patient registers or forms was explicitly stated in all national laws. To guarantee registration at treatment facilities, explicit regulations on patient follow-up were implemented. In Thailand, service integration between ART and mother and child health was strongly emphasized. WHO’s 2010 Option B PMTCT protocol (Prevention of Mother to Child Transmission) was followed in both countries.

Current research efforts

The development of long-acting treatments that, unlike the present antiretrovirals that require daily dosing, could be used only once a week, once a month, or even less frequently, is a top priority for researchers studying HIV treatment today. Such long-acting treatments may be less harmful and more affordable for certain people than daily medicines. They may also be more straightforward for specific individuals to stick with. The three categories of agents being researched are long-acting medicines, broadly neutralizing antibodies, and therapeutic vaccinations.

• Long-acting drugs

Longer-acting pills, as well as other formulations, including injections, patches, and implants, are among the next class of HIV medications that scientists hope to create. Due to the difficulty of making such products, NIAID (National Institute of Allergy and Infectious Diseases) formed a group of professionals who can promote interactions between the various sorts of researchers required to turn a concept for a long-acting HIV treatment into a practical solution.

The effectiveness of two novel long-acting HIV medications, raltegravir LA and rilpivirine LA, in patients who have had trouble adhering to traditional antiretroviral therapy, will also be studied by NIAID. Another research will examine whether raltegravir LA monthly injections and monthly infusions of VRC01LS, a broadly neutralizing antibody developed by the NIAID, can maintain HIV suppression in individuals whose infection was once under the control of antiretroviral therapy.

• Broadly neutralizing antibodies

Several antibodies for the treatment of HIV are being developed and tested by researchers at the NIAID Vaccine Research Center (VRC) and researchers supported by NIAID at other universities. Since antibodies can be altered to ensure long-lasting effects in the body and because they have common adverse effects, dosing might be done every other month or even less frequently. Crucially, the antibodies being studied are broadly neutralizing antibodies, or bNAbs, and may effectively prevent various HIV strains from infecting human cells in the lab.

According to clinical studies, injecting specific bNAbs into HIV-positive individuals can, though in a limited way, suppress the virus. Additional research has demonstrated that treating HIV-positive patients with a single bNAb promotes the emergence of HIV strains resistant to the antibody. As a result, antibody-based therapy will need a combination of several bNAbs or bNAbs and long-acting pharmaceuticals to successfully suppress the virus, just as antiretroviral treatment needs a variety of medications.

• Therapeutic HIV vaccines

A therapeutic vaccine might be the best option for treating HIV infection. A therapeutic vaccine, as opposed to one intended to prevent HIV infection, would be administered to those who have already contracted the virus.⁵ Quite a vaccine would improve the immune system’s readiness to combat any future resurgence of HIV, ending the need for additional treatment, possibly except for cyclical booster shots. By treatment or immunization, such a strategy might result in lasting undetectable HIV levels without consistent antiretroviral therapy.

Evidence that a therapeutic vaccination may conceivably modify the immune system in order to achieve long-term control of HIV is the existence of rare people with HIV who can control the virus spontaneously, either from the moment of infection or after stopping antiretroviral therapy.⁶ Yet, efforts to develop successful therapeutic HIV vaccines have so far come up short. The NIAID aims to expand the underlying research, especially to understand better immune responses that persistently suppress HIV and to boost the efficacy of those responses in order to aid in improving results.

Discussion

Pros and cons of various approaches:

Providing comprehensive HIV and family planning services improves healthcare professionals’ clinical skills, client satisfaction, financial resource mobilization, infrastructure provision, and availability of adequate human resources. It can also generate additional health-related resources for education and enhance knowledge on HIV and family planning services. About 5.3% of pregnant women have HIV, and 80% can get antiretroviral drugs to prevent the virus from spreading to their unborn children.

HIV-positive women in several African nations have an unmet need for modern family planning methods of more than 60%. Trying to ensure that women living with HIV have access to voluntary family planning supports the 90-90-90 global agenda, which the world is striving toward to meet the 2020 targets. An embedded family planning and HIV program can help women living with HIV with unmet family planning needs. The percentage of health facilities in sub-Saharan Africa offering comprehensive family planning services ranged from 10 to 61%.

It is well understood that an inclusive service can reduce missed opportunities and enable health professionals to offer HIV and family planning services simultaneously. HIV and family planning can be integrated, and there may be benefits as a result, but the factors in the health system will determine whether this integration is successful.⁷ It is a time-saving method that is affordable, has an acceptable waiting period, and saves clients’ time by preventing repeated visits. It can also reduce the number of times people needlessly visit healthcare institutions because women can get HIV and family planning services at the same place.

Statistical measures by researchers:

According to research done, the target site population included 1,200 service providers who were in charge of providing HIV and family planning services at public health centers in Thailand, 6,900,000 patients/clients who were in the reproductive age range (15–49), and 80 public health centers. Three hundred and one thousand three hundred and sixteen clients utilized family planning and HIV services in one year, including 75,329 clients who used family planning services and 225,987 who used HIV services. Jack Winston and Haber used a unified population proportion technique to obtain the sample size.

A two-stage sample procedure was used: 1) 31 of the 80 healthcare facilities were chosen using a straightforward random sampling method. In these 31 healthcare facilities with scarce funds, a proportionate distribution of patients and service providers was made. 2) From these health facilities, a stratified simple random sampling by the public health center and service type was used to choose 403 customers and 305 service providers (173 nurses, 83 nurse-midwives, 44 public health officers, and five physicians).

The information was statistically examined by descriptive analysis, summarizing frequencies, and cross-tabulation. Bi- and multivariable logistic regressions with estimated odds ratios, P-values, and 95% confidence intervals were used to examine the significance of the relationship between the variables. “The aim to use incorporated HIV and family planning services” was the dependent variable to calculate the logistic regression. Understanding the underlying variables for the intention of clients to engage in linked HIV and family planning services is crucial for effective facilitation.⁸ Marital status, family income level, and client satisfaction are the possible causes computed in multivariate logistic regressions.

Cultural aspects:

Tragedy looms over the spread of the illness, as with any pandemic without any known cure. Its unintended cultural consequences have been no less profound, igniting innovative medical research, difficult legal discussions, and fierce rivalry between researchers, pharmaceutical corporations, and academic institutions. Civil society organizations encourage wearing a red ribbon loop to show support and increase public awareness. Support groups provide extensive services, including healthcare, nursing, and rehabilitation services, housing, psychological therapy, meals, and legal assistance, as well as lobbying governments for funds to support learning, research, and treatment.

The AIDS Monument Quilt, currently displayed worldwide to collect money and highlight the human aspect of the tragedy, contains well over 48,000 panels that honor individuals who have died from AIDS. The United Nations launched World AIDS Day on 1^st December 1988. Geographic and economic variables are frequently deciding factors regarding access to the most recent medical therapies for AIDS.

Senegal’s licensed prostitutes get regular HIV testing, and the clergy, particularly Islamic religious leaders, attempt to educate the public about the illness. In Africa, there has not been much development. For instance, some HIV-positive African men have established the practice of sexually abusing extremely young children due to the false perception that doing so may somehow cure them of the condition. Like the misery of war and the horror of the Holocaust, HIV/AIDS has had a double-edged effect on the world of creativity and culture. It has inspired both heartbreaking works of art and encouraging tales of tenacity.

It was discovered in 2009 that the prevalence of AIDS among homosexual men in various African nations was dangerously high—about ten times higher than in the general male population.⁹ Also, many homosexual males in those regions allegedly had no idea that the illness could be passed from man to man. Many believe that the harmful preconceptions, false information, and unpleasant habits linked with AIDS can only be combated by better education.

Recommendations

Healthcare professionals must be knowledgeable about family planning and HIV. Both clients (18.2%) and service providers (67.9%) pointed out the value of training healthcare professionals to successfully integrate family planning and HIV service, as suggested by Jaden and Martinez. To deliver high-quality integrated HIV and family planning services, these qualifications must include theoretical concepts, professional values and conduct, psychomotor skills relevant to the medical care for family planning and HIV services, ruling skills, good communication, leadership, management, and team building.

Even if they previously only had expertise in one of these crucial functions, healthcare practitioners can increase their knowledge and proficiency in both. To administer the integrated HIV and family planning services successfully, it is imperative to employ sufficient and qualified healthcare personnel. The medical facilities’ professional staff delivered efficient integrated services. The health facility level should also mobilize additional resources, such as financial resources and infrastructure, to provide quality service.

Advocacy

The level of client awareness is the factor that requires attention in order to improve the successful deployment of integrated services. In this study, most clients (93%) said that raising awareness was one of their perceived benefits. As a result, clients must be well-informed and accept the benefits of an integrated service for them to be employed effectively during service delivery. Along with educating specific customers, all service providers, and program officials, including health promotion officials and programming managers, should be tasked with educating the community about the benefits of an effective health service.

Nonetheless, it has been demonstrated that waiting times impact patient satisfaction and, consequently, the efficient use of integrated services in healthcare facilities.¹⁰ The waiting period for integrated family planning and HIV services is reasonable, in contrast to the findings of this study; a longer waiting period would have a negative effect on people’s intentions to use an integrated HIV and family planning service. As a result, cutting down on client wait times can positively influence the desire to use integrated HIV and family planning services at the level of the health facility.

Environmental Stewardship

Environmental stewardship is the ethical use and preservation of the environment through sustainable methods that increase ecosystem resilience and improve human well-being. Participants in ecological education emphasizing stewardship have the chance to engage with their local ecosystems and access resources that can help them comprehend how human behavior affects the environment. These initiatives inspire individuals to participate in managing and safeguarding these resources actively.

It is crucial to look at HIV prevention inside the communication framework provided by faiths like Christianity. Prior research has concentrated on ways to manipulate social impacts, such as connecting religious beliefs to health practices or using religious standards as a means of positive or negative punishment. In this regard (1999), it was noted that highlighting spiritual pride or shame can promote attitudes toward health practices. Churches and other faith-based organizations could be HIV/AIDS prevention tools. Between scientific preventative initiatives and sociocultural circumstances, these organizations offer helpful social resources and commitment.

References

1. Badiaga S, Raoult, & Brouqui, (2008). Preventing and controlling emerging and reemerging transmissible diseases in people experiencing homelessness. Emerging infectious diseases, 14(9), 1353.
2. Madeddu and Fois, (2013). Chronic obstructive pulmonary disease: emerging comorbidity in HIV-infected patients in the HAART era? Infection, 41, 347-353.
3. Fidler D. P, (1996). Globalization, international law, and emerging infectious diseases. Emerging infectious diseases, 2(2), 77.
4. Chalwe V, Mukwamataba, Menten, Mulenga M, & D’Alessandro, (2009). Increased risk for severe malaria in HIV-1–infected adults. Emerging infectious diseases, 15(5), 749.
5. Karamouzian, Nasirian, Sedaghat A, & Hag (2014). HIV in Iran. The Lancet, 383(9922), 1040.
6. Prado, Schwartz & Szapocznik, (2007). It prevents substance use and HIV risk behaviors in Hispanic adolescents—Journal of consulting and clinical psychology, 75(6), 914.
7. Centers for Disease Control, Prevention (US), & National Center for Infectious Diseases (US). (1994). Addressing emerging infectious disease threats: a prevention strategy for the United States.
8. Schrag & Wiener, (1995). Emerging infectious disease: what are the relative roles of ecology and evolution? Trends in ecology & evolution, 10(8), 319-324.
9. Farmer, (1996). Social inequalities and emerging infectious diseases. Emerging infectious diseases, 2(4), 259.
10. Morens, & Fauci A. S, (2013). Emerging infectious diseases: threats to human health and global stability. PLoS pathogens, 9(7), e1003467.