The Center for Disease Control (CDC) published the first case of what later came to be termed acquired immunodeficiency syndrome (AIDS) in the United States in June 1981 in its Morbidity and Mortality Weekly Report (MMWR) (Gong, Xu & Han, 2017). In the article, the CDC described cases of rare lung infections among five gay men who were previously healthy and whose immune systems were not working (Koenig et al., 2022). In the following months of the same year, similar cases of individuals with weakened immune systems arose across the U.S., particularly among gay men. By the end of 1981, the CDC had recorded a cumulative total of 337 reported cases, and 130 of these infected people had already died by December 31 (Gong et al., 2017). Since the first official reporting of AIDS by the CDC in 1981, the HIV/AIDS epidemic continues to expand throughout the U.S. and other parts of the world (Govender et al., 2017). This paper, therefore, discusses HIV/AIDS outbreak, how it affected my CDC region and other communities outside of the United States, the risk factors associated with it, and how an outbreak of the disease can impact my community at the systems level.
The outbreak of HIV/AIDS in Region E
AIDS is caused by the Human Immunodeficiency Virus (HIV), and ever since the first case was reported in 1981 in the U.S., HIV/AIDS has become one of the world’s most serious developmental and health challenges (Elbe, 2020). The first official cases of HIV/AIDs recorded by the CDC in the MMWR were among five previously healthy young gay men in Los Angeles (Gong et al., 2017). With time, however, similar cases of individuals with weakened immune systems became common across the United States among children and adults, raising concerns throughout the country. Globally, there are currently approximately 38 million people living with HIV, and since the beginning of the epidemic, tens of millions of individuals have died of AIDS-related causes (Govender et al., 2021). One of the SCD regions impacted by this outbreak was Region E which consists of six states, including Wisconsin, Ohio, Minnesota, Michigan, Indiana, and Illinois. Other areas affected by the HIV/AID epidemic included Miami, Los Angeles, and New York, primarily large metropolitan areas.
When the CDC first reported the first cases of AIDS on June 5, 1981, health divisions across Region E began surveillance on similar cases. For example, the Wisconsin Division of health-initiated physician surveillance of similar cases of rare immune system suppression. In 1982, the state reported its first case of AIDS from a visiting non-resident. In 1983, however, the state recorded its first AIDS case from a resident and AIDS became a reportable contagious disease in Wisconsin. By 1986, Wisconsin had reported 100 HIV cases among homosexual adults and a single heterosexual case. Wisconsin first reported pediatric HIV cases in 1987, and by the end of 1989, the state had recorded over 500 reported HIV cases prompting the establishment of HIV prevention education initiatives. With AIDS becoming the leading cause of death for men aged between 25 and 44 years in the early 1990s, Wisconsin had already recorded cumulative deaths among HIV patients exceeding 2000 annually by 1995. The number of reported HIV cases and death continued to increase over the following years as HIV/AIDS became more prevalent in Wisconsin and other states in Region E.
Risk Factors Associated with HIV/AIDS Outbreak
The prevalence of HIV/AIDS globally in the late 20th and early 21st centuries became a major stumbling block in progressing human civilization and a significant concern for millions of people worldwide (Hernandez et al., 2017). As an important global public health issue, HIV has no cure and has claimed over 40 million lives. However, there has been increased access to effective diagnosis, prevention, care, and treatment of HIV infections, making it a manageable health condition, and enabling infected individuals to lead longer and healthier lives. Moreover, since its identification in the early 1980s, people have learned about how HIV attacks a person’s immune system, how it is transmitted, and how it results in AIDS, as well as some of the risk factors associated with the HIV/AIDS outbreak (Hernandez et al., 2017).
HIV often targets the body’s immune system, weakening a person’s defense against various infections. Therefore, with time, a person infected with HIV becomes immunodeficient because the virus destroys and impairs the functions of immune cells (Hernandez et al., 2017). In its most advanced stage, HIV infection results in AIDs, characterized by developing various long-term health conditions like cancer and a wide range of other infections. Some of the risk factors associated with the outbreak of HIV/AIDS include sharing contaminated needles, syringes and other injecting equipment among drug addicts, working in a profession that requires one to draw blood and collect other boy fluids like in medical professions and having condomless vaginal or anal sex (Hernandez, et al., 2017). More notably, having condomless anal sex among gay men was among the greatest risk factor associated with HIV/AIDS outbreak (Hernandez et al., 2017).
HIV transmission occurs through the exchange of body fluids such as vaginal secretions, semen and blood from an infected to uninfected persons (Eisinger & Fauci, 2018). With the transmission requiring direct contact of semen and blood from an infected individual with the exposed person’s blood system, various groups are at a greater risk of infections. These groups include men who have sex with men (MSM), people who inject drugs, health workers, and heterosexual individuals with multiple sexual partners such as sex workers (Eisinger & Fauci, 2018). However, the risk of infections among these groups is different and so should be the approaches to HIV transmissions among them.
One of the major risk factors associated with HIV/AIDS outbreak is having a profession that entails collecting body fluids or drawing blood, such as being a healthcare worker (Joyce et al., 2015). Accidental exposure of health care workers to percutaneous injuries, blood and body fluids while caring for HIV patients exposes them to the risks of becoming infected with the virus. Mucous membrane contact with a HIV patient may also expose a health care worker to the virus or even skin contact with chapped exposed skin (Joyce et al., 2015). Therefore, to avoid HIV infection while collecting patient’s body fluids and drawing blood, health care professional must use safety equipment like loves to reduce the risks of occupational exposure to the virus (Eisinger & Fauci, 2018).
Sharing contaminated needles and syringes, particularly among drug and substance injecting users in the other risk factor for HIV/AIDS infections (El-Bassel et al., 2014). In this case, if a HIV-negative person uses a syringe, needle, or other equipment that a HIV infected person has used, they are at a great risk of getting HIV. This is mainly because the injection equipment often have blood I them which contains the HIV, resulting in its transmission from an infected person to an uninfected one (El-Bassel et al., 2014). Therefore, with many prevalent cases of drug abuse among drug injecting youth and a limited number of available injection equipment, sharing these equipment increases the risks f HIV/AID transmission.
The epidemiological investigation conducted by the United States CDC on Gaetan Dugas, the first person identified with HIV/AIDS revealed some interesting facts about the risk factors associated with the disease. Referring to him as patient zero, the CDC discovered that Duga had multiple sexual partners in the Northern part of America (Gong et el., 2017). Further investigations revealed that general liberal attitudes towards sexual intercourse among MSM like having multiple sexual partners and unprotected sex in the early 1980s facilitated the rapid spread of HIV among the gay community (Hernandez et al., 2017). Notably, the most significant epidemiological determinant for exposure and transmission of HIV/AIDS was men having sexual intercourse with other men, particularly their sexual practices relating to having multiple sexual partners and having unprotected sex (Hernandez et al., 2017).
Compared to oral or vaginal sex, anal sex increases the risk of HIV transmission and other sexually transmitted sexual diseases (Singh et al., 2014). This is majorly because the rectal mucosa is more fragile than the oral or vaginal, making it easier for the susceptible person to acquire HIV. It is therefore no wonder that the AIDS epidemic overwhelmingly impacted MSM in the initial years compared to other groups (Hernandez et al., 2017). Due to the overwhelming impact of the AIDS epidemic on the gay community as most MSM saw their lovers, close friends and partners die, the gay community adopted various practices to minimize infections risks successfully by changing their sexual behavior. However, the achievements were short lived because of the resurgence in the number of gay men newly diagnosed with HIV/AIDS resurged in greater numbers in many developed countries (Hernandez et al., 2017). Major factors attributed to the re-emergence of the disease among MSM in this case were greater social acceptance of homosexuality and the re-adoption of risky sexual behaviors (Singh et al., 2014).
The Impacts of HIV/AIDS Outbreak in my community at a Systems Level
Disabilities, illnesses, and deaths associated with the effects of the HIV/AIDS epidemic can affect the society in multiple levels and ways (Trapero-Bertran & Oliva-Moreno, 2014). The epidemic’s impacts in this case can occur from a family level to the systemic level, thereby affecting how institutions like hospitals, schools, businesses, and local governments operate (Ritchwood et al., 2017). At the family level, families may experience incapacity of providers and loved ones, family members might also have to deal with the financial and physical burden of caring for the sick and experience the loss that comes with their death. Schools, businesses, hospitals, and other institutions may lose valuable personnel at the systemic level, especially when their most productive workers get infected with HIV/AIDS (Trapero-Bertran & Oliva-Moreno, 2014). In the long term, absenteeism increases in these institutions with many workers either taking time off to look after their sick loved ones or maybe due to HIV infections, thereby significantly reducing productivity.
HIV/AIDS outbreak in my community can also reduce school enrolment for young adults due to high rates of infections (Trapero-Bertran & Oliva-Moreno, 2014). Besides, payoffs to education investments may also decline due to young people’s high absenteeism and death rates. An outbreak of the disease can also threaten the community’s food security due to reduced food production and the inability of households to afford healthy diets (Trapero-Bertran & Oliva-Moreno, 2014). For example, with many people unable to work due to the toll the disease takes on them, particularly those working in food processing and agricultural sectors, the community’s food security becomes threatened. Moreover, most households within the community might direct most of their resources to HIV/AIDS drugs and treatment, leaving very little money for nutritious and healthy diets.
HIV/AIDS outbreak may also significantly impact the healthcare sector in various ways. For example, high HIV/AIDS infection rates may cripple the community’s healthcare sector because it would increase the general health expenditures for social and medical support and increase the exposure of healthcare professionals to infection (Ritchwood et al., 2017). Health care professionals are at greater risks of exposure to HIV due to the nature of their work, especially because they often have to draw blood and collect body fluids from a wide range of patients (Reif et al., 2014). Besides that, contact with HIV/AIDS patients makes them increasingly vulnerable to other infections such as tuberculosis associated with AIDS. With time, higher HIV infections among health care workers eventually affect the public’s supply of health care services due to shortage of health professionals (Ritchwood et al., 2017).
Investing in human health is one of the most significant aspects of economic growth and development alongside education (Elbe, 2020). Whereas the health sector maintains the value of human capital, education adds value to it. Therefore, an outbreak of HIV/AIDS epidemic can significantly reduce the returns of human capital investment especially due to high mortality rates among young people (Elbe, 2020). Moreover, the high cost of caring for HIV/AIDS infections can significantly strain the public expenditure resulting to limited attention to other health care concerns and needs of the community. Therefore, with time, a HIV/AIDS outbreak negatively impact the functions local businesses, hospitals, schools and local government (Elbe, 2020).
Comparing a community outbreak outside of the United States
Generally, developed countries like the United States albeit with difficulties, have managed to cope with the burden caused by the HIV/AIDS epidemic at the systemic levels better than less developed countries (Poku, 2017). A region that was most affected by the epidemic outside of the United States is Sub-Saharan Africa, which comprises the world’s least developed countries. Sub-Saharan Africa in this case is the hardest hit region globally, and it constitutes two-thirds of the total number of people living with HIV in the world (Poku, 2017). In Sub-Saharan Africa, the HIV/AIDS epidemic burden has had profound implications on various African community sectors, including the healthcare sector, academia, development and the state (Kagaayi & Serwadda, 2016).
Like in the U.S., high rates of HIV/AIDS infections among African communities in the Sub Sahara regions results to premature deaths among productive adults thereby compromising the stability of households (Kagaayi & Serwadda, 2016). High infection rates also result in reduced productivity in public and private institutions like schools and hospitals. Sub-Saharan countries like South Africa have higher numbers of people living in poverty than the United States. Therefore, unlike in the U.S. which has a greater percentage of financially stable individuals, communities in South Africa particularly those that were poor before the HIV/AIDS stressors are more likely to get into a state of chronic poverty (Poku, 2017). Moreover, due to high poverty rates, most members of these communities cannot afford medications to manage their conditions, resulting in higher mortality rates (Kagaayi & Serwadda, 2016).
Like in the United States, HIV/AIDS also had significant impacts n the labor and productivity of various South Africa’s institutions including schools, businesses, and hospitals. HIV/AIDS in this case results in impaired functioning of these institutions due to high rates of absenteeism from work and school, thereby leading to low productivity at the systemic levels (Poku, 2017). For example, increased absenteeism of teaching staff in schools has resulted in increased cases of school dropout among young adults. As a result, the general quality of education among various African communities in the sub-Saharan regions becomes significantly compromised (Kagaayi & Serwadda, 2016).
Regarding the healthcare sector, HIV/AIDS outbreak resulted in a shortage of health care professionals, increased demand for healthcare and higher expenditure in health care (Poku, 2017). Health workers in the U.S. and among South African communities are at a greater risk of contracting HIV/AIDS than other professionals. Similarly, when the infections become widespread among healthcare workers, they result in a shortage of healthcare professionals, eventually affecting the quality and supply of public health services (Kagaayi & Serwadda, 2016). Like in the U.S., HIV/AIDs also increased the community’s healthcare expenditure because the disease increased healthcare demand. However, a more developed country like the U.S. has more resources and is better equipped to address the HIV/AIDS outbreak than most Sub-Saharan communities (Elbe, 2020).
The Reporting Protocol of a HIV/AIDS outbreak from local levels to CDC
The reporting protocol for Region E concerning the outbreak o communicable diseases like HIV/AIDS begins with the local health department. In this case, the local health department represents the county where the patient resides (Koenig, et al., 2022). Therefore, with the current surveillance and reporting of communicable diseases like HIV/AIDS in the U.S. relying on electronic laboratory criteria, reporting outbreaks is easier and faster. As such, upon identifying a confirmed case of infection, the local health department can submit the report to the CDC within 24 hours of the diagnosis through the electronic laboratory reporting system or even immediately (Koenig, et al., 2022). Most notably, computer systems have made it easier for local clinical laboratories to transmit data to the CDC instantaneously.
Strategies for Preventing HIV/AIDS Outbreak
Patient education is one of the best strategies to prevent an HIV/AIDS outbreak in the CDC region E. Education in this case plays an important role in curbing the transmission of HIV/AIDS through capacity building. It also informs individuals on the best ways to avoid transmission, and helps reduce stigma, dependence, and discrimination of people living with HIV/AIDS (Eisinger & Fauci, 2018). Education also gives people access to all information and facts about the disease, empowering them to charge their lives. For example, to reduce HIV/AIDS infection rates, communities should start educating young people on best preventative measures such as the importance of using condoms while engaging in sexual intercourse from an early age. Apart from education, timely diagnosis of HIV infections is the other strategy for preventing HIV/AIDS outbreak (Eisinger & Fauci, 2018). Timely diagnosis in this case enables individuals living with HIV/AIDS to engage in care and treatment early on after the diagnosis, thereby increasing the percentage of people living with the suppressed version of the disease. Such interventions also enable the local government to target prevention resources on populations with the greatest risks and regions with the highest burden of the disease (Eisinger & Fauci, 2018). Moreover, with timely diagnosis and engagement in care, local governments can prioritize and implement the most efficient preventive strategies on a large scale.
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