Essay on Global HIV/AIDS Epidemic

Introduction

The Human Immunodeficiency Virus and Acquired Immuno-Deficiency Syndrome (HIV and AIDS) epidemic has become one of the most important public health concerns in recent times and it is a matter of concern in the Philippines because the number of cases has increased intensely. According to the Joint United Nations Program on HIV and AIDS, since the beginning of the HIV epidemic, approximately 78 million people have been infected with HIV, with approximate 35 million people dying due to AIDS-related illnesses and an estimated 36.7 million people living with HIV worldwide by the end of 2015 (UNAIDS, 2018). In 2017 the number of people newly infected with HIV and the number of people who died from AIDS-related illnesses was approximately 2.1million and 1.1 million, respectively (Foundation for AIDS Research, 2018).

In the latest data from the Philippines AIDS registry of the Department of Health (DOH), as of July 2019, there are 1,111 newly confirmed HIV-positive individuals were reported which is 29 % higher as compared to the same month last year (n=859). Of the newly diagnosed ninety-four percent (n=1048) were male with a median age of 28 (age range is 6-64 years old) whose mode of transmission is by a male to male sexual contact (n=699). While twenty-three percent (n=254) reported having sex with both males and females and thirteen percent (n=146) have sex with both males and females. Another mode of transmission includes sharing of infected needles accounting to 1%, mother to child transmission is less than 1%. Of the newly diagnosed18% were already in HIV stage 3 and 4 advanced infections. Thirty-four percent 34% were from National Capital Region (NCR), sixteen percent (16%) were from Region 4A and followed by Region 3 twelve percent (12%), Region 7, eight percent (8%), and Region 11 five percent (5%). This data comprised a total of 69,512 HIV and AIDS cases in the Philippines from Jan 1984 (when the first case was reported) to July 2019. Based on needlestick injury only 3 cases from 1984 to the present.

With this trend, stigmatizing attitudes to these people could increase and documenting it would be very difficult and the extent of workplace discrimination is difficult to ascertain, which is more health-related wherein HIV clients are denied for health services. Stigmatizing attitudes against people living with HIV/AIDS has been documented since the beginning of the HIV epidemic, both related and unrelated to healthcare provision.

This means tackling stigma in its many forms by removing punitive laws, policies, and practices that undermine key populations and other vulnerable groups or block their access to good quality healthcare services. At the same time, it is important to ensure that healthcare workers, in their workplace, are enjoying their labor rights free from stigma and discrimination and are in a protective environment that allows them to exercise their roles, rights, and responsibilities, and to protect themselves from occupational exposure. By continuing to put people first and ensuring that no one is left behind in the AIDS response, ending the AIDS epidemic in every region, in every country, and in every community and population are possible as HIV and AIDS-related issues usually evoke strong emotional reactions including anxiety and withdrawal, the healthcare workers' knowledge of such issues may indicate their level of preparedness in caring for people living with HIV and AIDS. Given that, healthcare workers are expected to provide care and accurate information on this subject matter to patients and their relatives, as well as to the general public, they must have credible and accurate knowledge of the disease.

Knowledge, attitude, and practices regarding HIV and AIDS are one of the cornerstones in the fight against the disease. Adequate knowledge about HIV and AIDS is a powerful means of promoting positive attitudes and engaging in safe practices. Many prevention programs have focused on increasing knowledge on transmission to overcome misconceptions that could prevent behavioral change towards safe practices and reduce the stigma against people living with HIV and AIDS. Stigmatizing attitudes have shown to be strongly associated with misconceptions about HIV transmission and are negative attitudes towards people living with HIV and AIDS.

Looking at the Philippines data, there has been no systematic study on the attitude and behavior of healthcare workers toward PLHIVs. Most of the information gathered was just based on anecdotal pieces of evidence and the occasional media reports on print and online. An unfavorable attitude of healthcare workers toward PLHIVs is a public health issue as it will bring repercussions in the provision of quality healthcare service to these people. At the same time, it would hinder the rights of people HIV and AIDS to health care.

To address this gap, this study aims to determine and collect information about the knowledge, attitude, and practices on HIV and AIDS of the different healthcare workers in Region IV-A. The results of the study could be a basis for effective and non – discriminatory patient interaction in the future thru policy enhancement.

Statement of the Problem

This study aims to determine the level of knowledge, attitude, and practices of healthcare workers in Level II government health facilities in Region IV-A towards people living with HIV and AIDS.

It will specifically address the following:

1. What is the profile of the respondents in terms of?
   1. Profession;
   2. Length of years in service;
   3. Training/Seminars attended for the last 3 years
2. What is the extent of knowledge of the respondents in terms of?
   1. Personal Knowledge;
   2. Health Care situation;
   3. Policy on the health facility
3. What is the attitude of the respondents towards patients living with HIV/AIDS in terms of?
   1. Blame for infection;
   2. Desire for separation;
   3. Sympathy and equality of care
4. What are the practices of the respondents in terms of?
   1. Confidentiality;
   2. Patient Handling
5. Is there any significant difference in the knowledge, attitude, and practices of the respondents in HIV and AIDS when their profile is considered?
6. Is there any significant relationship between the knowledge, attitude, and practices of the respondents in HIV and AIDS?
7. What policy can be proposed to enhance the program in HIV and AIDS?

Hypotheses of the Study

1. There is no significant difference in the extent of knowledge of the respondents regarding HIV and AIDS when their profile is considered.
2. There is no significant difference in the attitude of the respondents regarding HIV and AIDS when their profile is considered.
3. There is no significant difference in the practices of the respondents regarding HIV and AIDS when their profile is considered.
4. There is no significant relationship between knowledge, attitude, and practices HV and AIDS when their profile is considered.

Significance of the Study

The result of this study will benefit the following:

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• Patients. The study result will be of importance to patients with HIV and AIDS (specifically if the result will be the bases of policy enhancement on HIV and AIDS in the healthcare setting) wherein stigma and discrimination will be avoided.
• Healthcare Workers. The study result will be the basis of strengthening health programs and activities in the promotion of health, particularly on HIV and AIDS.
• Educational Sector. The result of the study can be used by the academic sector specifically colleges offering medical programs to evaluate them programs with the possibility of incorporating the correct attitude in handling patients with HIV and AIDS.
• Stakeholders. Local and international development partners and organizations can utilize the result of the study to provide funding to address identified gaps and needs. And Civil Society Organizations (CSOs) and Non-government Organizations (NGOs) can also utilize the result to make project proposals and implement activities to address unmet needs.
• Policymaker. The study result will be the basis of promulgating laws policies or guidelines to enhance and upgrade the policies and programs of the different organizations.
• Medical and Allied Professional Organization. Medical institutions and professional organizations like the Philippine Medical Association (PMA), the Philippine Association of Medical Technologists (PAMET), the Philippine Nurses Association (PNA) and other medical organizations. These organizations can utilize the result of the study to enhance or align seminars, discussions, symposiums, and orientations to address the need for information about HIV and AIDS.
• Hospital Administrator. With consideration of the study result, hospital administration can use this to serve as an eye-opener for private and public hospitals and clinics to ensure that their health personnel are equipped with the right knowledge, practices, and values on how to handle patients with HIV and AIDS without discrimination and prejudicing their confidentiality.
• Researcher. Knowledge and experience to be gained from this study will enhance the researcher’s ability to better address and support healthcare workers.
• Future Researchers. The study results will be beneficial among researchers and other further researchers as reference material.

Scope and Limitation of the Study

The study determined the knowledge, attitude, and practices towards people living with HIV and AIDS of the following healthcare workers namely, doctors, dentists, nurses, medical technologists, physical therapists, midwives, x-ray technicians, laboratory technicians and nursing aide who have direct interaction with people living with HIV and AIDS. Selected healthcare workers from selected government health facilities in Region IV-A are the target of the study. Excluded in the study are medical specialists or consultants and nutritionists.

The respondent has knowledge in HIV and AIDs such as personal knowledge, and healthcare situation, while attitude towards patients living with HIV and AIDS and practices include confidentiality, medical records keeping and patient handling. The study also investigated if there are existing policies on handling HIV and AIDS in their respective hospitals, finding if differences in knowledge, attitude and practice on HIV/AIDS and if there is a relationship between their knowledge, attitude, and practices. The study has been conducted from November 2019 to February 2020.

Definition of Terms

• Attitudes. It deals with how healthcare workers treat patients in them interactions during clinical encounters and how healthcare workers relate to and communicate with the patients.
• Confidentiality. It is the right of the patients to have personal, identifiable medical information kept private. Such information should be available only to the physician of record and other health care and insurance personnel as necessary.
• Healthcare situation. Relates to the knowledge of the respondents in terms of high risk and low risk in HIV infection.
• Healthcare workers (HCW). Operationally defined as professionally trained health caregivers including doctors, nurses and laboratory scientists/workers, occupy a potential vanguard position in AIDS preventative programs and the management of diagnosed patients.
• HIV/AIDS. A global epidemic and is considered one of the greatest public health problems both in the developed and developing world.
• Level II health facility. Are non-departmentalized hospitals that provide clinical care and management on prevalent diseases in the locality?

Level I Health facility.

• Medical Record Keeping. Refers to any relevant record made by the Healthcare workers at the time of after, a consultation or application of health management among PLHIV.
• Patient Handling. Refers to a program that reduces the risk of injury for both healthcare workers and patients while improving the quality of patient care.
• Knowledge. It refers to the understanding of the healthcare workers concerning transmission, and protection against HIV/AIDS.
• Practices. This refers to what they do or do not do on the aspect of HIV and AIDS such as handling and confidentiality and patient recording.

Chapter 2. Review and related literature

This chapter will review the related literature and studies that will give direction to the study. Included is the conceptual framework and theoretical framework that will be used in this study.

HIV and AIDS

It is known globally that HIV is a virus that is spread through certain body fluids that attacks the body’s immune system, specifically, the CD4 cells, often called T cells. Over time, HIV can destroy most of these cells (CD4) that the body’s immune system can’t fight off infections and disease. Because these cells help the immune system fight off infections. Since no treatment is yet available, but only to suppress the multiplication of the virus, HIV reduces the number of CD4 cells in the body which is crucial for immunity. Due to this, opportunistic infections take benefit of a very weak immune system. If this happens, the person is considered to have AIDS (CDC, 2014).

Several scientists concluded that the virus that causes AIDS came from a type of chimpanzee in Central Africa as the source of HIV infection in humans. This simian immunodeficiency virus or SIV could have been transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and met their infected blood. Studies show that as far as 1800, HIV may have jumped from apes to humans. Over the decades, the virus slowly spread across Africa and later into other parts of the world. It is said that the virus has been in the United States since at least the mid to late 1970s (CDC, 2014).

Medicine was given to HIV patients, antiretroviral therapy (ART), helps people slow down the progression of the disease from one stage to the next if taken the right way, every day. According to WHO (2018), it can also dramatically reduce the chance of transmitting HIV to someone else.

According to WHO (2018)), stage 1 is the acute HIV infection wherein 2 to 4 weeks after infection, people may experience a flu-like illness, which may last for a few weeks. This is the body’s natural response to infection. When people have acute HIV infection, they have a large amount of the virus in their blood and are very contagious. But people with acute infection are often unaware that they’re infected because they may not feel sick right away or at all. To know testing must be done with a fourth-generation antibody/antigen test or a nucleic acid (NAT) test. Stage 2 is the clinical latency (HIV inactivity or dormancy). This is sometimes called asymptomatic HIV infection or chronic HIV infection according to WHO. During this phase, HIV is still active but reproduces at very low levels. The reason why people may not have any symptoms or get sick during this time. Different people will have different manifestation in this stage. For some, even with the medication of ART, this period can last a decade or longer, but some may progress through this phase faster. It’s important to remember that people can still transmit HIV to others during this phase, although people who are on ART and stay virally suppressed (having a very low level of virus in their blood) are much less likely to transmit HIV than those who are not virally suppressed (WHO, 2014). At the end of this phase, a person’s viral load starts to go up and the CD4 cell count begins to go down. As this happens, the person may begin to have symptoms as the virus levels increase in the body, and the person moves into Stage 3 (WHO, 2014).

Stage 3 is acquired immunodeficiency syndrome (AIDS). This stage is the most severe phase of HIV infection. HIV patients can get an increasing number of severe illnesses, called opportunistic illnesses. Without medication, people with AIDS typically survive for about 3 years. Common symptoms of AIDS according to WHO (2014), include chills, fever, sweats, swollen lymph glands, weakness, and weight loss. People are diagnosed with AIDS when their CD4 cell count drops below 200 cells/mm or if they develop certain opportunistic illnesses. People with AIDS can have a high viral load and be very infectious. The only way to know for sure whether you have HIV is to get tested. Knowing your status is important because it helps you make healthy decisions to prevent getting or transmitting HIV. Some people may experience a flu-like illness within 2 to 4 weeks after infection (Stage 1 HIV infection). But some people may not feel sick during this stage. Flu-like symptoms include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, or mouth ulcers. These symptoms can last anywhere from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others. These symptoms, that doesn’t HIV because it can also be caused by other illnesses. But, the only way to determine whether you are infected is to be tested for HIV infection.

No effective cure currently exists for HIV. But with proper medical care, HIV can be controlled. Treatment for HIV is called antiretroviral therapy or ART. If taken the right way, every day, ART can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS (the last stage of HIV infection) in a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly if someone who does not have HIV (CDC, 2017)

Global HIV/AIDS Epidemic

According to UNAIDS, since the beginning of the epidemic, more than 70 million people have been infected with HIV and about 35 million people have died of HIV. Globally, 36.7 million [30.8–42.9 million] people were living with HIV at the end of 2016. An estimated 0.8% [0.7-0.9%] of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 25 adults (4.2%) living with HIV and accounting for nearly two-thirds of the people living with HIV worldwide. As reported by UNAIDS in their global report (2017), 36.9 million people worldwide are currently living with HIV, and AIDS 2. 1 million children worldwide are living with HIV. There were approximately 36.7 million people worldwide living with HIV and AIDS at the end of 2016.