Healthcare Disparities in HIV Treatment

1 Healthcare Disparities in HIV Treatment Vulnerable populations face disparities in healthcare, which places them at an increased risk for poor health outcomes. Vulnerability could occur due to low socioeconomic status, lack of insurance, presence of a chronic illness, increased age and being from an ethnic or racial minority (De Chesnay & Anderson, 2019). Such populations may have difficulty in accessing healthcare services which may delay their diagnosis, leading to poor health outcomes. HIV is a chronic condition that can make one susceptible to increased morbidity and mortality. This paper discusses on people living with HIV as the vulnerable group in focus.

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2 Aspects of HIV HIV is an immune-deficiency condition caused by a virus. The HIV virus infects the body through infected body fluids during sex, blood transfusion, birth from mother to child and when sharing contaminated needles or sharps. After an initial infection, the virus replicates within the cells of the immune system and might take several months to years before noticeable symptoms are seen. Overtime, the virus overpowers the cells of the immune system, leading to an active HIV infection which then progresses to AIDS. Active HIV infection manifests with fever, rash, fatigue, skin infections and gastrointestinal problems. In AIDS, opportunistic infections and malignancies become rampant.

Why People Living With HIV Are Considered Vulnerable HIV is a chronic health condition, thus requiring long term treatment and management. In persons’ already diagnosed with HIV, comprehensive care is needed to prevent progression to AIDS. This requires additional costs which may eventually affect the socioeconomic status of the person, hindering their ability to afford a healthier lifestyle. Persons living with HIV also face a lot of stigma. They are likely to be discriminated against, which impacts their access to essential services including healthcare, education and other social services. This is fueled by the negative perceptions of them, causing them to be sidelined in their communities. This affects their healthcare utilization as they are afraid to come out and seek care. As a result, their health may deteriorate quickly affecting their prognosis and even leading to mortality. The health status of HIV infected persons also makes them vulnerable. The fact that their immune system is weakened means that they are prone to infections, hence having poorer health status and outcomes compared to the normal population.

Most Common Communicable Diseases in HIV

3 HIV weakens the immune system making one susceptible to infections. Thus, HIV positive individuals are prone to having both communicable and non-communicable infections.

Communicable diseases are transmissible from one person to another. Tuberculosis (TB) is one of the most threatening communicable diseases in HIV. The risk of being sick with TB is increased in HIV infection as well as the progression of latent TB to TB infection and disease.

TB shortens the lifespan of HIV positive individuals and is the leading cause of death in people living with HIV (Bruchfeld, Correia-Neves & Källenius, 2015). The presence of TB disease in HIV infection is often considered an AIDS-defining condition.

Discuss Barriers to Healthcare and Access to Care for People Living With HIV Stigma and discrimination remain to be the major determinants in barriers to healthcare utilization among HIV positive individuals (Johnson et al., 2015). They associate seeking care with their health status being known or disclosed to others. As a result, they fear being rejected, disrespected, excluded or ill-treated by their peers or in their communities. In most countries, free HIV care services are provided. However, they may be underutilized due to transport costs to the facilities, fear of being seen in such facility and inadequate respect or discrimination from staff in the facilities. Persons infected with HIV may also be reluctant to seek treatment due to denial, absence of symptoms and believing in spiritual healing. Other barriers to care include having unsupportive partners, confidentiality concerns and tight work schedules.

Issues People Living With HIV Faces in Relation to Community/Public Health Nursing HIV is a major public/community health concern as it affects the health outcomes of a community. Health prevention and promotion strategies are important in this patient population to decrease mortality and improve their health. However, this may not be optimally met due to people’s attitudes, discrimination and stigma towards HIV positive individuals. This may prevent

4 them from actively engaging in health prevention and promotion measures. Also, it may contribute to them being sidelined in public/community health projects. The psychological impact of living with HIV including frustrations, depression and anxiety may also impact their overall health outcomes. Lack of family support, social rejection, relationship problems and family conflict also affects their community and health engagement, impacting their outcomes (Dejman et al., 2015).

Evidence-Based Practices That Improves Health Outcomes in People Living With HIV The use of anti-retroviral therapy has immense improved health outcomes in people living with HIV, causing them to live longer and healthier lives. Early initiation of anti-retroviral therapy helps in protecting the immune system thus preventing the progression to AIDS (Maina, Mill, Chaw-Kant & Caine, 2016). Furthermore, it reduces the risk of transmission to healthy individuals. Other than anti-retroviral therapy, healthy nutrition and lifestyle contributes to better health in HIV infections. Infected individuals are advised to adopt safe sexual practices to avoid re-infection with different strains of the virus which leads to poorer outcomes. Social support programs have also been evidenced to improve outcomes in HIV infected people by helping them to deal with psychological and social impact of the condition and also by providing education and support.

Resources That Will Improve Health Outcomes in People Living With HIV Information technology can be used to provide information and support to people living with HIV. The adoption of technology in HIV care helps in improving adherence to medication and also reducing transmission to key populations who are risk (Taggart, Grewe, Conserve, Gliwa & Isler, 2015). There are several websites online that provides useful information on HIV prevention, care and management. This includes governmental sites and organizations such as

5 the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) among others. Additionally, there are numerous online support groups for HIV which provides empowerment and also helps HIV positive individuals to cope with their condition.

Some of these support groups include the Thunder Bay Online Counseling Center, Positive Peers, LivePerson, HIV/AIDStribe and The Well Project among others. There are also Facebook groups such as Poz Place and mobile apps such as the myHIVteam.

6 References Bruchfeld, J., Correia-Neves, M., & Källenius, G. (2015). Tuberculosis and HIV coinfection. Cold Spring Harbor perspectives in medicine, 5(7), a017871.

De Chesnay, M., & Anderson, B. (2019). Caring for the vulnerable. Jones & Bartlett Learning.

Dejman, M., Ardakani, H. M., Malekafzali, B., Moradi, G., Gouya, M. M., Shushtari, Z. J., Alinaghi, S. A., & Mohraz, M. (2015). Psychological, Social, and Familial Problems of People Living with HIV/AIDS in Iran: A Qualitative Study. International journal of preventive medicine, 6, 126. https://doi.org/10.4103/2008-7802.172540 Johnson, M., Samarina, A., Xi, H., Valdez Ramalho Madruga, J., Hocqueloux, L., Loutfy, M., Fournelle, M. J., Norton, M., Van Wyk, J., Zachry, W., & Martinez, M. (2015). Barriers to access to care reported by women living with HIV across 27 countries. AIDS care, 27(10), 1220–1230. https://doi.org/10.1080/09540121.2015.1046416 Maina, G., Mill, J., Chaw-Kant, J., & Caine, V. (2016). A systematic review of best practices in HIV care. Journal of HIV/AIDS & social services, 15(1), 114–126. https://doi.org/10.1080/15381501.2015.1116037 Taggart, T., Grewe, M. E., Conserve, D. F., Gliwa, C., & Isler, M. R. (2015). Social media and HIV: a systematic review of uses of social media in HIV communication. Journal of medical Internet research, 17(11), e248.