Epidemiology and Control of Communicable Diseases AIDS

Question: Discuss about theEpidemiology and Control of Communicable Diseases for AIDS. Answer: Introduction HIV/AIDS is a global epidemic affecting people of all ages. AIDS is a syndrome that results from progression of HIV infection, a virus that majorly affects the human immune system. The impact of the disease is varied in different places all over the world, others experiencing its effects more in the population than others. For instance, the place of interest in this writing is South Africa whose population suffers largely from the impacts of the disease both economically and socially. According to the statistical reports provided in 2012 (1), approximately 6.4 million individuals in South Africa had the disease, a number that represented about 13 % of the countrys entire population. Moreover, only 48 % of these people have access to antiretroviral therapy. As compared to about 39 million people according to the 2015 global statistics of people living with HIV, 6.4 million is quite a large number contributed by a single country given that the incidence rate is also about 380,000 new c ases yearly. These statistics also showed a rise in the cases of those having the disease from the previous statistics released in 2008 by about 1.2 million. This rise can be attributed to the socioeconomic factors, cultural factors as well as health seeking behaviors in the affected societies in South Africa that are the key determinants of health in the region. (3) The prevalence was higher and continues to be so in the rural areas as compared to the urban areas where there is a comparatively low population of those affected as well as a low number of new infections per year. Notably, there are more females than males that have the disease. (2) The most affected age group of these females are those aged between 30-34 years most of them being fertile a factor that also contributed to further infections to children under no medical supervision and provision of prevention of maternal to child transmission services. The age groups of men affected more are those between 35 to 39 years. Among the teenage populations, prevalence in females is eight times that of their male counterparts, a factor that is closely associated with sociocultural issues such as high poverty levels, early marriages, having multiple partners among both males and females and increased unreported rape cases among other factors. (4) The specific groups that have been identified as having the highest risk of infection are those with multiple partners, those living with disabilities and those that use alcohol and other recreational drugs. The ecology of the disease is influenced by social, political, economic and cultural life factors. HIV is transmitted mainly through having contact with body fluids such as blood, semen, pre-seminal fluids, rectal fluids, vaginal fluids and breast milk. The primary routes of entry of the virus into the human body are through the mouth, prick with a contaminated object, open wounds and unprotected sexual intercourse with an infected individual. (5) Social factors play a significant role in the disease ecology of HIV/AIDS. For instance, the highest risk is among gay people, injectable recreational drug users, and sex workers. There is increased risk of infection if one has multiple sexual partners. Also, if one has ever had sexually transmitted infection, their chances of having HIV infection is slightly higher than other individuals. Other factors that play a role in the ecological development are high poverty levels that may prompt some people to engage in sexual activities for finan cial stability. Furthermore, hygienic hospital conditions, procedures, and services are dependent on the availability of resources. Policies stipulated by authorities concerning health play a role as well as cultural beliefs and practices. HIV virulence varies from one place to another and from one individual to another. Disease progression in some individuals may be rapid while slower in others due to differences in immune factors that are associated with heredity, nutrition, early initiation of treatment, age, and other comorbidities. There are no vectors or reservoir hosts in the ecology of HIV/AIDS as it is transmitted from person to person because the survival period of the HIV virus is said to be less than 8 minutes which also depends on the environmental factors. (6) The major aspects that have contributed in these increased infections in South Africa are sexual debut at an early age among young individuals below the age of 15 years, multiple sexual partners, noncompliance in the use of protective measures such as the use of condoms, lack of awareness of HIV status, poor health education among most citizens and lack of adherence to antiretroviral therapy as well as safe breastfeeding practices. (1) More than 11% of those aged between 15 and 24 years are reported to having unprotected sexual experiences before their 15th birthday. (4) More males of this age group reported this to be true than their female counterparts. On the other hand, having multiple sexual partners and using recreational drugs such as alcohol increased the risk of exposure to HIV infection as compared to those exhibiting a single aspect in this category. (7) Another determinant that plays a role in determining the incidence rates and prevalence of the disease not only in South Africa but also the entire world is the access and proper utilization of the available prevention and management strategies. Access can be influenced by various factors such as motivation among the general population, infrastructure, transport, and health education and sensitization about the significance health services among the citizens. Use of condoms is one such strategy that is common globally. Its use also prevents transmission of other sexually transmitted diseases and unplanned for pregnancies. In South Africa, 36.2% of the sexually active population aged above 15 years use condoms. Its regular use is common in urban places as compared to rural areas even though those who prefer not to use it may not be aware of their and partners HIV status. (3) Only 45% of the entire population of both males and females are aware of their HIV status. (4) There are various control measures that have been employed in the area in the effort to prevent transmission from one person to another through the many ways by which it can be spread and therefore curbing new cases of infection. Some of these measures are also meant to prevent further deterioration of the condition of those already having the infection but improve their quality of living. (7) One of these interventions is distribution and campaign for the use of both male and female condoms. There has been an increase of distribution and the use of condoms especially male condoms in the country. However, some individuals prefer not to use them due to cultural and spiritual beliefs besides the lack of information. More other reasons to reduced use across all populations are poverty, diverse attitudes towards HIV in various communities and partner influences. Secondly, prevention of mother to child transmission (PMTCT) is one of the strategies that have shown a significant impact towards curbing the transmission of the disease. (7) There has been 68% reduction of mother to child transmissions since 2010 in South Africa with the improved access to antiretroviral therapy by expectant women. The same factors that affect compliance with other strategies such as culture, stigma, economic issues, staff shortage and lack of accessibility to health care facilities have hindered the 100% effectiveness of most of these strategies including PMTCT. Male circumcision has been attributed to a reduction in the risk of HIV transmission by scientists by 60%. The World Health Organization has recommended it as one of the strategies that can be used to reduce the transmissions. Consequently, it is actively utilized in South Africa not only due to this discovery but also due to it being one of the cultural practices common among all of the countrys communities. Although it contributes to this reduction, it does not offer 100% effectiveness, and it is therefore combined with other methods. (1) Antiretroviral therapy (ART) is the most commonly advocated for a measure of curbing infections and deterioration of general health of those infected. (7) This therapy is initiated once one is one is diagnosed with the infection. However, 60% of the individuals having access to ARVs have not achieved required viral suppression. Moreover, few infected children have access to ARVs as compared to the adults. Funding of these control measures is from international and local government and non-governmental organization support. (2) Nevertheless, a number of barriers have been outlined as the primary contributors to partial and not full meeting of the set objectives of the control measures. These barriers range from economic, social, cultural to legal issues. (7) Financial challenges due to poverty and low social class have a big impact in determining health-seeking behaviors and alternative health services apart from the conventional health facilities such as hospitals. In the same way, sociocultural issues such as stigma, religion, and discrimination of those suffering from the disease affect individuals and their adherence to medication. (4) Some health care workers also exhibit the same discrimination just like the general population, discouraging the affected from living positively. (1) The status of women in many societies in South Africa has also determined their access to healthcare, education and job opportunities. On the same note, gender-based violence has also played a role in the spread of HIV/AIDS among females. It is stipulated that women are twice more likely than men to be infected. For instance, in the sub-Saharan Africa, those already having the infection comprise of 60% females and 40 % males of all ages. This phenomenon can be attributed primarily to gender inequalities, varied access to healthcare domestic and sexual violence against females, instances that significantly contribute to their increased vulnerability to HIV. (7) The disease does not only affect ones health but also the household, community national and global economic productivity and prosperity. The prevalence level difference in various countries is associated with the diversity and variations in culture with regard to antiretroviral use, contraceptive use, literacy levels, circumcision among other cultural practices. The global determinants of HIV/AIDS as well other sexually transmitted diseases are categorized into two distinct groups; sexual behavior risk factors and influential risk factors. Health care providers density being one of the influential risk factors it influences the health seeking behavior patterns among the entire population. Shortages of healthcare providers such as doctors, nurses, and nutritionists have increased the incidence and prevalence of HIV. There is no enough social support in most places as well as satisfactory health care services a factor that increases the vulnerability levels of these individuals to the opportunistic infections. Thus most nongovernmental aid organizations have been established in various countries to provide these services majorly in the most affected countries such as South Africa.(8) On the other hand, there is a big difference in prevalence among people coming from Muslim and Christian backgrounds in most countries according to the comparative research done for these two religions. The prevalence is relatively higher in individuals with a Christian background. This can be attributed to the doctrine differences in these two religions. Drug abuse, homosexuality, extramarital affairs, and sexual intercourse before marriage are highly prohibited in the Muslim religion, and they normally attract severe punitive measures. (3) This can be another reason that explains the reason why in Africa, the disease is more common in the sub-Saharan Africa where South Africa is among the countries located in that region. Thus high prevalence is experienced in other southern Africa countries such as Swaziland 25.9%, Botswana, 24.8% and Lesotho, 23.6%. (1, 8) Adolescent fertility rates are another factor that influences the prevalence and incidence rates as well as the progression of the disease globally. (2) There have been an increase in fertility rates among adolescent aged between 10-19 years and those aged between 15-25 years of whom there are most early marriages, unwanted pregnancies, genital mutilations especially in specific parts of Africa, sexual and gender-based violence. It is approximated that 14 million of teenagers conceive and give birth worldwide each year and 58 million of the females aged below 18 are married due to these circumstances. Sex prevalence among those aged below 15 years is also very high at 48% worldwide a factor that predisposes them to HIV infections. (8) In conclusion, HIV/AIDS is an epidemic immune disease that has social and economic impacts on affected people globally. South Africa is one of the countries that have been significantly affected with a high incidence rates and infection cases. Most of the affected groups in the population are females of all ages and children. It is transmitted from one individual to another through body fluids and this is impacted by social, cultural and economic factors within the society which can also be altered to reduce the rate of infections. Various methods have been utilized to prevent infections including use of condoms, male circumcision, and introduction of ARV therapy for the infected, sterilization of invasive and reusable equipment in health facilities, implementing interventions that reduce risks of mother to child transmission, health education among others. Most of these strategies have been deemed to be effective when adherence by those using them is high. 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