Pre-exposure Prophylaxis (PrEP), is an HIV prevention policy mostly for gay and bisexual people living in the UK. It involves using ARVs on those that are HIV negative and other comprehensive packages to prevent HIV transmission (Steward Kate, 2016), The importance of the policy is to create awareness and initiate people on the effective of ANT by health professionals to suppress HIV activity in the bodily fluid to prevent the risk of HIV transmission and other STI to one another (Eakle et al, 2018). Several researchers including the PROUD Trial discovered that PrEP is scientifically proven successful to reduce 86% exposure of HIV transmission. This had caused a stable rate of HIV transmission in the UK for past years. However, PrEP faces the challenges of ignorance of its efficacy. People are more likely to engage in unprotected sex to use PrEp afterwards. ( McCormack et al., 2015). Secondly, failure to comply with dosage intake as it is required to be taking daily to increase the adequate level of drugs in the tissue that are vulnerable to HIV infection (Fonner et al., 2016). For some years now PrEP has been unavailable in the UK because of the cost and not funded by the NHS. Instead is been under deliberation by the NHS England and HIV Clinical Reference Group (CRG) as they are planning to make it available from this year (PHE, 2019). To break these barriers, individuals need to be fully informed regarding PrEP efficiency, adherence of ARV drugs and encouraged to consistently use a condom to avoid being exposed to HIV.
HIV and AIDS prevention intervention programmes are strategies established by different government, private and charity agencies to minimise the spread of HIV through merging of behavioural, biomedical, and structural interventions (Avert, 2019). South Africa National Strategic Plan (NSP) 2017 to 2022 is a 5 years initiative in partnership with the National, local government, civil society, and private organisations to tackle HIV, TB and STIs. The mandate of this scheme is to establish a zero-tolerance on infection, minimise unequal right and sexual violence against women, health inequalities, stigma, and discrimination on those living with HIV (NSP, 2017). NSP was successful to break the cycle of HIV transmission and extended the intervention to the target population using different organisation. It provided the resources needed and deliver an integrated treatment to HIV which generated motivating feedback from society ( Kathlyn et al., 2018).
Nevertheless, health care workers were unable not to trace the patient’s data during the period of care in the result of the poor information system. Secondly, 70% of health facilities experience a shortage of ARV drugs and health care workers. This because of a reduction in the 2016 fiscal budget by the national department of health (NDOH) results in an insufficient fund to hire doctors (Kathlyn et al., 2018). However, introducing an electronic data recording system to monitor ART will improve accurate monitoring and evaluation services for delivering long term care (Meg Osler et al., 2014). Again, using a national supply chain action plan monitoring scheme linked with, stakeholders, DOH and National Health Insurance Policy can resolve these issues of shortage ARV of drugs and health care workers (Christopher, 2016; DOH, 2016).
HIV Prevention England (HPE ) is a national co-ordinated integrated scheme sponsored by PHE and part of Terrence Higgins Trust registered charity (THT) in the UK in collaboration with NHS clinics, General Practitioners, local authorities, and faith communities (PHE, 2019). HPE goals are to deliver a contemporary service utilising support network, outreach, and mass media to inspire the society and extend adequate support and standard care to those vulnerable to HIV in England (Avert, 2019). HPE intervention was successful to expand HIV testing facilities, HIV Self-Testing approach (HIVST), distribution of free condoms, immediate diagnostic and treatment to stop further transmission and tackled health inequalities within people living with HIV and AIDS (THT, 2019; NICE, 2018). Although, individuals were concerns about a breach of confidentiality due to a public HIV test. The fear of testing HIV positive as this could cause stigma in society. Nevertheless, introducing a straightforward HIVST with an accurate diagnostic result will make it available for people to use anytime, reduce stigma, promote confidentiality and HIV testing uptake. Although, there is a risk of harm with HIVST. Therefore, individuals need to be counsel before uptaking HIVST to prevent self-harm (Doddds et al., 2018; Wizel et al., 2016).
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Health inequalities was another challenge encountered during the implantation of NSP initiatives in South Africa. Health inequalities are socio-economic differences in health outcomes that exist between individual of diverse gender, age and ethnic background which causes poor health conditions, increases in morbidity rate and low life of expectancy (Upton & Thirlaway). While health equity is the fairness in the distribution of health resources to obtain adequate health and wellbeing of the individual in a community regardless of the protected characteristics, (APHN, 2015). Marmot Review Fair Society Healthy lives (2010) suggested that lack of education, low income, poor housing, unemployment, unhealthy lifestyles choices, social activities people engage in, the decisions made by the government and poor access to health services are significant causes to health inequalities. These variations are been referred to as The Determinant of Health (Dahlgren and Whitehead, 1992).
South Africa experience an unfair distribution of income because 20% of the population top hierarchy’s is living with 68% of the country’s income should be invested in the health care system, support services, housing and transportation for the entire society (IMF, 2020). Those living with HIV and AIDS were unable to afford HIV drugs and access proper medical treatment. There are 2.8 number of hospital beds and 1.3 nurses and midwives per 1000 population in South African (World Bank, 2015). Again, People living with HIV and AIDS are been stigmatised and discriminated from their peers, families, and society. They find it difficult to get a job as unemployment among the youths is uncommon to compare to the emerging market. There is a reduction in labour supply, poor generation of tax and revenue. Consequently, has caused a shrank in Gross Domestic Product (GDP) and the Income Per Capita in urban areas are twice as the rate identified in rural provinces. Gender inequality and violence against women has been a major concern. The women are less likely uneducated, and unemployed because they are not allowed to participate, and advance in the political systems (Sia et al., 2016). About 8.8 per in 100,000 population of women are physical injuries, sexual assault and murdered by their intimate sexual partner causing them vulnerable to HIV infection (Frade & De Wet-Billings, 2019).
To reduce health inequalities in South Africa, the issue of corruption should be addressed by the government and ensure that everyone benefited from the country resources. Again, the government should implement policies that will improve access to women education, social grant, standard health care system to all, create employment opportunities and skills development for the youth to boost taxation and revenue and reduce the high cost of living (Omotoso & Koch, 2018). Moreover, women should be given equal right to take part in the political and socio-economic system and their sexual reproductive right should be respected by all. Also, family members and peers of an individual living with HIV and AIDS should avoid stigma and discrimination to reduce health inequalities (Amin, 2015).
In the UK not all communities are benefiting from HPE. 51% of bisexual and gay communities living in the UK are more likely to experience stigma and discrimination in schools and workplaces (THT, 2020). They are unable to access sexual health services due to the places they live while some might not want to attend because they do not want to reveal their sexual identity to health care workers. Those that attend are more likely to stay a longer time during the appointment. This is because there is 2.9 number of hospital beds and 8.3 nurses and midwives per 1000 population in the UK. Those that lived in a more deprived area are likely to experience poorer health outcome as the average life expectancy is ………………. All these factors have an impact on people’s mental health and result in less life expectancy (World Bank, 2015; PHE, 2014).
To reduce health inequalities the UK government should implement policies that target a change in a behaviour lifestyle, invest in more deprived so that people that live in this area will have full access to health care services. There should be a fair distribution of the income and provision of social support to an individual living with HIV and AIDS. Investment should be made in housing so that individuals without shelter could access homeless service, mental health support and social protection for those on low income and unemployed (Smith & Morkandlik, 2015). Moreover, provision of immediate access to ART to those living with HIV is likely to increase their life expectancy 15 years longer to compare to those that started treatment later (May et al, 2011).
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