The use of antiretroviral therapy (ART) has transformed HIV infection into a seemingly manageable chronic illness from the previous perception of being a terminal disease. Research indicates that ART plays a crucial role in reducing the viral load and the possibilities of secondary transmission. Accordingly, this culminated in the conceptualization of an innovative HIV prevention paradigm where successful treatment scale-up could lead to the complete eradication of AIDS. Majority of the 35 million individuals who have been diagnosed with HIV reside in resource-limited settings (RLS). As of 2016, 17 million people living with HIV (PLWH) have been receiving ART with a target of 20 million being set by the World Health Organisation by the year 2020. Perhaps the most affected victims of HIV/AIDS pandemic is the children where it is approximated that 2.2 million children under the age of 15 are living with the virus. Additionally, children constitute 13 percent of new infections and account for 17 percent of annual mortalities (World Health Organization, 2016). Nearly 1.2 million HIV positive children reside in15 nations which have been categorized in the Emergency Plan global focus countries. In some states located in southern African nations, between 40-60 percent of deaths of children under the age of 5 years have been accredited to AIDS. In instances where treatment and care are lacking, 35 percent of the children die in their first year of life, 50 percent on their second year and 60 percent on their third birthday (Reda & Biadgilign, 2012). Equally important is the fact that children living in developing are more susceptible to diseases such as pneumonia, malnutrition, and tuberculosis (TB).
Equally important is the fact that studies indicate health disparities exists among the Latino community who are among the ethnic minorities that are adversely affected by the effects of HIV/AIDS. One of the factors that have contributed to the prevalence of the AIDS pandemic is the barriers associated with initiation of ART. Delay in the integration of treatment creates a lasting impact in enforcing adherence in the HIV continuum while also creating a sense of negative feedback by discouraging newly diagnosed patients from participating in treatment. From the perceptions of community health workers (CHWs), some of the factors that are instrumental to the adherence and initiation to ART are patient education comprising of components such as the counsellor's ideology of HIV normalcy and ART literacy; socioeconomic factors such as substance use and poverty; community and individual perspectives of HIV including stigma, social support, denial and fear of disclosure; perspectives on ART such side effects and fear of lifelong treatment and discontent with the healthcare system (Halkitis, Wolitski & Millett, 2013). Moreover, fear of lifelong therapy remains a barrier that is seemingly exclusive to initiation efforts while substance use is predominantly concerned with impeding adherence. Consequently, the most ideal approach of creating a reliable prevention strategy is through the combination of public education and enforcing the need for adherence to ART especially amongst ethnic minorities who are disproportionately affected.
The objective of this study is to highlight the approaches and of providing education to public health personnel on the ideal intervention of introducing ART to a specific population of Hispanics with HIV. Further, the study aims to identify methodologies of educating those who are infected on how to develop coping mechanisms that help them deal with the challenges they face to become more compliant to treatment thus facilitating successful progress in treatment,
1. What is the relevance of patient education to alleviating instances of stigmatization and ensuring adherence to treatment?
2. To what extent do socioeconomic factors interfere with adherence to ART in Latino community?
3. What is the efficacy of providing social support in ensuring initiation and progress of ART amongst Hispanics?
The future of research in instituting preventive interventions for HIV/AIDS is founded on the paradigm shift that exclusively focuses on target communities such as the Latino. In essence, this implies that focus has shifted from individuals to incorporate a comprehensive strategy where social and structural modules are essential. Patients who can overcome personal barriers such as being in denial may also be subjected to a wide range of extensive community barriers which comprise of poverty, stigma, and challenges in navigating through healthcare environment (Kippax & Stephenson, 2014). The existence of impediments towards a continuum of care mandate the need for reinforcement of ART and long-term guidance. Moreover, CHWs may act as mediators if a conflict ensues which may be triggered by support families or through status disclosure as the patient attempts to participate in ART. The recent advances in ART regimens coupled with lifelong knowledge and treatment including the side effects of ART are likely to experience more successful outcomes. In essence, this project is aligned with the universities mission of promoting social change amongst PLWH through interventions that are education-focused. Without a doubt, the creation of public awareness on HIV/AIDS and the sensitization on the need for adherence to ART is essential as a comprehensive preventive strategy.
The Context of Doctoral Project
The ideal setting for the doctoral project would be in a public health institution which will facilitate the collection and analysis of data on patients who have been diagnosed with HIV. The eligible participants would be comprised of CHWs who have more than two years professional experience and work with HIV patients drawn from the Latino community. Moreover, the objectives of the doctoral project that focuses on comprehending the challenges encountered during the process of initiation and adherence to ART are explained to the patients before a written consent permitting the recording of interviews and transcription is issued (Suthar et al., 2013). Such a setting would ensure the collection of reliable in RLS where patients are faced unique socioeconomic factors that result in competing priorities between striking a balance between providing for the family and executing professional duties. In this project, in particular, the researcher is likely to realize that by mitigating the effects of socioeconomic strain through the appreciation of a patient's limitation is essential in augmenting positive outcomes in the treatment of HIV/AIDS. Additionally, introducing subsidies to transport costs and the expansion of the role of public health officers to incorporate ART distribution to the patients regarded as being medically stable would culminate in improved linkage to mundane care and subsequently reduce drop-off.
Sources of Evidence
Indeed HIV/AIDS persists as a serious threat to the livelihood and health of individuals drawn from the Latino community. In 2015, Hispanic accounted for nearly 25 percent of all the new diagnoses of HIV in the U.S despite only representing 18 percent of the total population. Of the new infections that were diagnosed in 2015, 87 percent of the diagnosis was in men while 21 percent was in women (Chen, Gallant & Page, 2012). This occurrence may be accredited to the prevalence of factors such as discrimination, stigma and homophobia which increases the prospects of negative outcomes amongst PLWH from the Latino community. Moreover, migration patterns, low educational levels and language barriers serve to compound on the problem of initiation and continuity of ART. More often than not, undocumented Hispanics avoid treatment interventions for HIV/AIDS due to the fear that they may be deported or arrested. As a result, the Center for Disease Control and Prevention (CDC) has increased funding to support health departments which deal with individuals from ethnic minority groups.
Information is to be collected through the use of People Living with HIV Stigma Index which denotes a questionnaire that has been exclusively developed for people diagnosed with HIV and is to be administered by public health professionals (Zhang et al., 2012). Mostly, this instrument is essential in evaluating stigma and discrimination against PLWH from various perspectives. Additionally, the HIV-KQ-18 may be utilized and it assesses the level of knowledge of individuals on the need for adherence to ART and avoiding the risky sexual behavior.
Medical records are regarded as being highly confidential hence they are protected by a comprehensive list of the legislature. Information on HIV may be considered as being sensitive which prompts the need for issuance of an informed consent which defines the limits of confidentiality. This suggests that the participants in the survey have to authorize the utilization of information by third parties (Idele et al., 2012). On the other hand, the limits to confidentiality may be demonstrated by the mandatory decree where public health officials are required to create a report on HIV/AIDS as a fundamental approach towards preventing the prevalence of the epidemic.
Aspects of prospectus alignment
Being aware of one's HIV status is fundamental in stimulating initiation and adherence to ART including the reduction of mortality and morbidity among PLWH. Accordingly, sufficient safety measure ought to be incorporated to prevent instances of blood contamination or infections through the improper use of needles. Nevertheless, advances in technology and improvements in equipment handling have resulted in w levels of occupational exposure which saves money that would have otherwise been used for treatment purposes.
Secondary data types of HIV and sources of information
Online databases including NIH ad Pubmed may be used as the primary sources of research information while books and peer-reviewed journals obtained from Google scholar comprise of the secondary sources of information.
Chen, N. E., Gallant, J. E., & Page, K. R. (2012). A systematic review of HIV/AIDS survival and delayed diagnosis among Hispanics in the United States. Journal of Immigrant and Minority Health, 14(1), 65-81.
Halkitis, P. N., Wolitski, R. J., & Millett, G. A. (2013). A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men. American Psychologist, 68(4), 261.
Idele, P., Gillespie, A., Porth, T., Suzuki, C., Mahy, M., Kasedde, S., & Luo, C. (2014). Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. JAIDS Journal of Acquired Immune Deficiency Syndromes, 66, S144-S153.
Kippax, S., & Stephenson, N. (2012). Beyond the distinction between biomedical and social dimensions of HIV prevention through the lens of a social public health. American journal of public health, 102(5), 789-799.
Reda, A. A., & Biadgilign, S. (2012). Determinants of adherence to antiretroviral therapy among HIV-infected patients in Africa. AIDS Research and treatment, 2012.
Suthar, A. B., Ford, N., Bachanas, P. J., Wong, V. J., Rajan, J. S., Saltzman, A. K., ... & Baggaley, R. C. (2013). Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS medicine, 10(8), e1001496.
World Health Organization. (2016). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. World Health Organization.
Zhang, W., O'Brien, N., Forrest, J. I., Salters, K. A.,...
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