Scientists discovered HIV or the Human Immunodeficiency Virus in 1985. HIV may be transmitted to other people through exchange of body fluids like semen, blood, vaginal secretions and breast milk (Cichocki). The most common way of spreading HIV is sexual contact. Other means include needle sharing in injection of drugs, childbirth and breastfeeding. HIV attacks and damages the immune system of the body. As it reproduces, the body becomes more susceptible to infections and illnesses.
HIV is the virus that causes AIDS or the Acquired Immune Deficiency Syndrome. AIDS is considered a global pandemic. Pandemic is defined as an epidemic or an outbreak of an infectious disease that extends its scope to a large region or even global (Pandemic). AIDS has inflicted not only a particular region, but has likewise afflicted and affected people from different countries. It is not limited to a particular nation, area, race, status, age or gender. It spans different demographics. AIDS was initially thought of as a disease specific to homosexuals only, but succeeding cases and discoveries gave way to a better understanding of AIDS and the HIV as the virus that causes it. AIDS was ruled out as a condition confined to homosexuals only, but is a condition that could be acquired by anyone who undergoes the possible HIV transmission channels or routes.
Since the formal discovery of HIV, around 40 million people have been infected worldwide and out of this number, 12 million have died. Since 1982, over 60,000 people in the UK have been infected with HIV but the bulk of the reported cases come from developing countries like Africa, where HIV infection is responsible for more than half of adult deaths (Health encyclopaedia: HIV and AIDS, 2007).
There is no known cure for AIDS or there is no known treatment to rid the body of HIV, but there are drugs or medications that can hamper the growth or reproduction of HIV, and thus likewise hampering the damage to the immune system (Is There a Cure for AIDS?, 2006). The question now is how to prevent HIV infection and how to care for those who have already contracted the disease. The risk groups need more than awareness but a thorough education on the prevention of HIV and AIDS. Aside from prevention, risk groups should also be made aware of the signs and symptoms, and the avenues where they could go for help or assistance. More importantly, those afflicted with the disease require proper health care. People who are infected with the virus develop different ailments as a result of the virus. They develop different conditions which result to diverse needs. Responses should be tailored to the severity of the need. Health care should not only be afforded to people with HIV and AIDS depending only on their health conditions, but the diversity of the personal and social backgrounds of these people should be considered.
Responding and acting on the diverse health care needs of people with HIV or AIDS require partnerships or collaborations between and among different sectors and groups. Those from the health care industry are the primary contact persons for health care provisions, but they are not the only group who can help people with HIV or AIDS. The family, community, and the government also have their own responsibilities and share in the provision of health care. Provision of health care does not merely involve doing clinical tests and giving drugs or medications, it is also about health programs initiated by the government and implemented with the help of the families and communities. Public awareness and education programs are not only significant to those afflicted with the disease, but these programs also benefit the community as a whole. The people in the community benefits from the public awareness and education programs because they are given enough information so they can stay clear of the same predicament.
The appropriate provision for the diverse health care needs of people with HIV and AIDS can be afforded to them if steps will be taken to counter stereotypes and prejudices in the health care system. Some do not even get health care because of discrimination.
This paper aims to explore the diverse health care needs of people with HIV and AIDS, and tackle the impact of stereotypes, prejudices and assumptions in health care delivery. It also aims to establish the roles of nurses and other professionals in meeting these diverse health needs.
The Difference between HIV and AIDS
Common misconception is that HIV and AIDS are one and the same. Some use these two terms synonymously. It is important to identify each from the other. HIV or the Human Immunodeficiency Virus is the virus responsible for causing AIDS while AIDS or the Acquired Immune Deficiency Syndrome is HIV in its most advanced form. HIV initially attacks white blood cells called CD4 cells which protect people from illnesses and then it transforms the CD4 cells into virus factories that produce viral copies (Cadman, 2003). Growth of the virus kills CD4 cells and thus weakens the immune system. AIDS results when too many CD4 cells are lost due to severe attacks by HIV. The body is then unable to fight off infection and is most likely to develop serious and even deadly infections.
HIV and AIDS are different from each other in that AIDS is not immediately present at the onset of HIV. A person may be HIV positive for a long period of time without signs of disease or a person may only have mild to moderate symptoms. If no treatment is applied, HIV will eventually weaken the immune system. HIV treatments are composed of medications that slow down the copying process of virus (HIV Treatment and Prevention). These medications are not cures but they are means to provide more protection against infections of different kinds.
The 1980s saw the emergence of the terms HIV and AIDS. But it was believed that the virus has been existent even before this period. There were just no recorded data. In 1959, a man from Africa died of a mysterious disease and it was only decades later after examining his blood samples that his death as being caused by complications from HIV was confirmed (Cichocki). In 1981, homosexual men living in Los Angeles and New York in the United States were afflicted with a rare lung infection named as Pneumosystis Carinii Pneumonia and around the same time, cases were reported that a rare tumor, Kaposi’s Sarcoma appeared on different body parts of homosexual men (What Is AIDS?, 2004). There were also other infections connected with weakened immune defenses which were reported in the 80s. Most of the reported cases involved homosexuals, people with hemophilia and intravenous drug users. Because of these reports, it was assumed that sexual and blood transmissions were the main causes for the proliferation of infections. The virus responsible for the decrease in the immune defenses was identified in 1984 and was referred to as HIV or Human Immunodeficiency Virus in 1986.
The cases were not limited to those reported in Los Angeles and New York but other occurences of similar infections affecting the immune system were likewise reported from different regions and from different countries. The risk groups were comprised of individuals from different ages and gender including homosexual men who have sex with each other, heterosexual men and women, recipients of blood, hemophiliacs, infants born to mothers who are HIV-infected, male and female who inject drugs, and health workers who are exposed to HIV-infected blood.
The Diverse Health Care Needs of People with HIV/AIDS
Before we go to a discourse on the diverse health care needs of people with HIV or AIDS, let us first identify the definition of diversity. Diversity is generally defined as the inclusion of many different kinds of things or people in something (Cambridge Advanced Learner’s Dictionary, 2003). Diversity may also be defined in three other ways: a variety of something, social inclusiveness like ethnic, socioeconomic and gender variety in a society, and discrepancy or a deviation from what is expected or what is normal (MSN Encarta Dictionary: Diversity). For the purposes of this paper we will refer to the general definition of diversity which is many diffferent kinds of things in something or a variety of something. People with HIV/AIDS have different types of health care needs. Their needs are very varied due to the differing conditions that they acquire and the varied situations that they are in.
Provisions of health care should be based from the severity of conditions or infections of people with HIV/AIDS. Since the conditions or stages of the ailment are diverse, techniques and modes of service delivery should likewise be diverse. One mode of service delivery may be effective for one patient, but may be ineffective for another. Like any other person, individuals react and respond differently to assistance or treatments. Patients have different physiological characteristics and psychological capacities. Their bodies have been nourished differently. They have differing backgrounds and socio-economic status. They come from different cultures and thus have various views and beliefs about certain things. They belong to families and communities which may or may not greatly vary with one another. Some families and communities foster atmospheres of acceptance and understanding, while some express hostility and shame.
In determining the health care needs of people with HIV/AIDS, all possible factors should be considered. By looking at all the aspects that make-up a person, provision of the appropriate health care services will be effective in helping the patients deal with and accept their conditions. Appropriate means would also aid the patients to be more cooperative in the health processes involved. They would eventually come to fully realize that all the efforts aim to help them live a better life inspite of their illness.
Generally, the most important health care needs of people with HIV/AIDS are psychosocial and physiological needs. Aside from taking care of the physical health of the patient, it is also vital that mental health be nourished. Along with physical and mental health, social health is likewise necessary to be developed as this will help the patient live a normal life beyond the bounds of his illness. Social interaction with people who are also HIV positive is very helpful in the creation of support groups. Group membership helps destigmatize the ailment (Baumgartner, 2001). Membership in a group fosters the feeling of acceptance and fellowship or not being alone. Social interaction with people without the illness is also vital as it encourages incorporation within the normal activities of life.
People with HIV/AIDS need comprehensive care which is tailored to their specific and individual needs. Those who experience either irregular or consistent periods of disability require nursing and other support services which will complement medical care (Schoff & Schore, 1997). Support services include assistance with living activities like finding adequate housing for AIDS self-care, child care if person has children, applying for public support, transportation to the medical care location, aid in going back to work if person is well enough to work again, and mental health services for those with mental illness. Drug treatments or prolonged medications should likewise be monitored to make sure that patients stick to their medication schedule. Comprehensive care may sometimes involve home-based care depending on the situation and conditions of the patient. This involves the family in the caring for the needs of the person with HIV/AIDS. Education and training are very important provisions for family members who will be responsible for the home-based care program. This program is still under the monitoring of health care professionals.
Manifestations of psychological difficulties of people with HIV/AIDS include depression, anxiety, paranoia, fatigue, weight loss and even anorexia. People with HIV/AIDS often harbor negative reactions to their illness damaging their self-image, specifically their body image and they hold on to feelings of low self-worth, self-hatred and even suicidal views (10 PRACTICAL TIPS FOR WORKING WITH PEOPLE WITH HIV, 2003). Health practitioners and care providers should be sensitive to the feelings of people with HIV/AIDS. Understanding and helping them overcome these strong negative emotions result to effective patient-carer relationships.
Individual and group activities that develop self-esteem also help in building self-acceptance. Peer support counseling is effective in developing self-esteem as it encourages the feeling of not being alone. It is always better to feel that you have somebody with the same conditions who is helping you deal with your emotions or personal battles. Peer education works hand in hand with peer support counseling. Peer education is done by educators who are themselves positive with HIV and they connect with people through the services they use like an injecting drug user who is HIV positive may be given education through a needle-exchange program (How to reach HIV positive people?, 2007).
Medical care access is an important need of people with HIV/AIDS. Unable to access medical care is more often than not a result of poverty. Location may also be a factor. One problem is the transportation cost going to the medical centers or facilites. The location of the housing and poverty both affects the capability of the person to travel to the medical center. The house may be far and cost of transportation may be high that the person is unable to afford spending money or does not have money to spend at all. Medical centers and facilities may be available and well-equipped with well-trained personnel, but not everyone can go to these centers. The underprivileged just don’t get the chance to avail of the medical services. Private and public service groups, along with governments set up programs so that medical centers with the very able medical personnel will be brought to locations where there are no near medical facilities that the people can go to. This way people who have HIV/AIDS and who are living in poverty will be given the chance to experience medical care.
Nutritional support is another need that should be considered as a diverse matter because nourishment or food intake is different from person to person. HIV results to micronutrient deficiencies which makes the body need more nourishment. Then again, one person may be healthier than another because of the kinds of food that they took in their lifetime, so nutritional support may have different effects for different people. Nutritional support, as the term implies is just a support to medication. Healthy eating habits or proper nutrition still play an important role in managing infections resulting from HIV, but there is no evidence that nutritional interventions can be used as alternatives to taking appropriate medications at the prescribed time (Gevers, 2007).
Financial support is another need of people with HIV/AIDS especially those who are underpriveleged. They do not have the means to support their medications and the care that they need. Some lose their jobs as a result of the illness while some lose a significant part of their income in times and money spent for treatments.
Psychosocial needs are also very important as these refer to the stigma attached to HIV or AIDS. Along with stigma come the feelings of fear, rejection, sorrow and hopelessness. People with HIV/AIDS tend to retreat into their own shells to hide from discriminations, prejudices and unfair judgments towards them. Providing care, understanding and support in these times would really be beneficial to them.
Roles of Nurses and other Professionals in Meeting these Needs
Nurses, midwives and other healthcare professionals are the primary care givers. Being the primary support of people with HIV/AIDS in their health care needs, the nurses and these professionals should be the first to provide understanding and willingness to help. They should be true to their responsibilities and duties regardless of who the patients are. Unfortunately some members of the medical profession discriminate against people with HIV/AIDS particularly nurses who are reluctant in participating in counseling, testing and reporting of workplace incidents (Nurses at the Forefront of HIV/AIDS, 2006).
The primary role of nurses and other health care providers is to provide immediate attention and action to the health needs of patients. In the case of helping people with HIV/AIDS, nurses are responsible in a whole range of medical services which are not limited to the giving of medications but also extend to counseling or psychological and emotional care and services involving collaborations with other agencies or institutions to help the patients. As a further role, nurses being a primary care giver should be involved in the planning and implementing of programs and policies. This way, they can really contribute information and ideas as they are the people who are the most involved with the patients and their health programs. They should know which policies and programs are effective and which need revisions or improvements.
In order for nurses as well as other health care providers to fulfill their roles, they should possess skills and competencies in doing the job. It is their responsibility that they be equipped with the knowledge and skills to provide proper health care to people with HIV/AIDS. Thus, it is important that education and training of nurses be constant and progressive to keep them up to date with current developments in the field of HIV/AIDS and healthcare.
Confidentiality is a right as well as a need of people with HIV/AIDS that should be respected. I consider it the role of nurses and other health care providers who are privy to the medical details of patients to maintain confidentiality of records. It is part of their function as much as it is a duty towards the upholding of the human rights of the patient. The importance of confidentiality is included in The NMC Code of Professional Conduct. Patient information should be treated as confidential by registered nurses, midwives or specialist public health nurses, and in cases where information is required to be given outside the medical team, consent of the patient should be obtained (The NMC code of professional conduct: standards for conduct, performance and ethics, 2004).
The Impact of Stereotypes, Prejudices and Assumptions in Health Care Delivery
There is a stigma attached to the terms HIV and AIDS. Stigma is defined as the circumstances of an individual who is barred from full acceptance in society (What is Stigma?). People with HIV/AIDS are not accepted by the social majority. People with HIV/Aids are more often than not discriminated against. This discrimination stems from the assumptions and stereotyping of other people who are not educated enough about HIV and AIDS. These people base their stereotypes on the little information that they have about HIV and AIDS. They usually relate HIV with promiscuity, homosexuality and drug addiction. They discriminate against everyone with HIV or AIDS regardless of how the person contracted the virus. From communities and public venues, this unfair treatment extends to the workplace, the school and even ironically, the health care centers or facilities like clinics and hospitals. HIV-related discriminations include employment, housing, insurance, education and services (HIV-RELATED STIGMA AND DISCRIMINATION, 2005). These discriminations violate the human rights of people with HIV/AIDS.
At the workplace, it is not only the employers who discriminate against HIV-positive people, but co-workers also play a major role in the continuous existence of the stigma. There are laws against discrimination but people are not aware of it. “One in three people is not actually aware that discriminating colleagues who are HIV positive is against the law, according to a survey of the National AIDS Trust” (One in three unaware that HIV discrimination is illegal, 2006).
In some areas or societies, laws and policies may increase the stigma and discrimination against people with HIV/AIDS like regulations or restrictions on international travel and migration, and compulsory screening and testing of groups considered to be high risk (Why is there stigma related to HIV and AIDS?, 2007). There are also reported cases of discriminations against people with HIV/AIDS by health care systems. Manifestations of discrimination include HIV testing without consent, non-attendance of hospital staff, withheld treatment, denial of hospital medicines and facilities, and lack of confidentiality. These discriminations are products of lack of knowledge and to a certain extent of ignorance to HIV/AIDS and how it is transmitted. This is ironic as health care providers or health system personnel should be the first to know the basics of medical illnesses or conditions. They should be well-informed and educated being in the medical industry.
People who have HIV/AIDS have diverse needs. This is no different than any of us, as no two persons are exactly alike in their needs. The difference is that their diverse needs are specialized and they need special care tailored to their specific needs. In providing for their diverse health care needs, nurses and other health care professionals play major and important roles. They are the primary care givers. To a certain extent the lives of people with HIV/AIDS depend on them. Their roles are not only limited to providing medicines or physical assistance, but they have roles to fulfill in the psychological and emotional aspects. They serve as physiological and psychosocial caregivers. They not only act as medical care experts but they also act as counselors and liaisons to other agencies and institutions. It is likewise important that they participate in the planning and implementations of programs and policies.
Stigma and discrimination relating to HIV and AIDS are barriers to the effective battle against the epidemic of HIV and AIDS. Fear of discrimination often leads to people avoiding or refusing diagnosis or treatment. They fear exposing themselves because they will be refused of employment, housing, insurance and even health services. They may even be rejected by families, colleagues and friends.
Laws against discrimination of people with HIV/AIDS may deter further occurrence of incidents but policies cannot reform stereotypes or prejudices. Laws may punish offenders but the root cause will never be solved. The ultimate solution is education, information dissemination and public awareness at the grassroots level. Proper information about the virus and how it is transmitted are key points that should be discussed. Prejudice is most often a result of fear and fear is the outcome of the unknown or ignorance. Eradicating ignorance would lessen the fear and would eventually lead to a decline in prejudice.
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