Abstract
The Human Immunodeficiency Virus (HIV) poses a serious threat to community health. Adolescents are particularly vulnerable to the risks of HIV. This paper discusses the current situation with HIV in relation to Healthy People 2020. The discussion and epidemiology of HIV are provided. The paper discusses and critiques recent research relating to HIV prevention in adolescents. The situation with HIV in the state of Ohio is discussed. The goal of the paper is to define the role of the community nurse in the primary, secondary, and tertiary prevention of HIV.
Keywords: the Human Immunodeficiency Virus (HIV), adolescents, community nurse, prevention.
The Human Immunodeficiency Virus (HIV) poses a serious threat to community health. Much has been written and said about HIV, its risk factors, and prevention strategies. Nevertheless, millions of adolescents in all parts of the world suffer the symptoms and consequences of HIV and AIDS. HIV “is the virus that leads to AIDS. HIV belongs to a subset of retroviruses called lentiviruses (or slow viruses), which means that there is an interval – sometimes years – between the initial infection and the onset of symptoms” (HIV, 2000). Adolescents are particularly susceptible to the risks of HIV and AIDS. The main goals of Healthy People 2020 are to reduce the number of people with HIV, increase access to quality care and health outcome for HIV-infected people, and reduce the scope of HIV-related health disparities in the U.S. (Healthy People, 2011). The role of the community nurse is to help decrease the incidence and complications of HIV in adolescent populations through primary, secondary, and tertiary prevention.
The Human Immunodeficiency Virus (HIV) remains one of the most complicated and challenging health conditions. Its aggressiveness and effects on the immune system make the task of curing the disease virtually unachievable. Once in the bloodstream, HIV infects and damages CD4+T cells (HIV, 2000). It replicates, disabling the immune system and leading to the eventual destruction of immunologic and lymphoid organs (HIV, 2000). These processes are central to developing AIDS in humans (HIV, 2000). HIV has ceased to be a disease of gay white males. It currently affects all population layers and groups. The prevalence rate of HIV in the United States is 447.8 per 100,000 persons (Braithwaite, Taylor & Treadwell, 2009). 46.1 percent of them are African Americans (Braithwaite et al, 2009). Whites represent 35 percent of the general HIV population, and 17.5 percent of the HIV population are of Hispanic origin (Braithwaite et al, 2009). In the epidemiology of HIV, adolescents are the most vulnerable group. 16 percent of teens in the U.S. are African Americans; they also account for almost 70 percent of reported HIV/ AIDS cases in the U.S. (Braithwaite et al, 2009). Most cases of HIV among American teens are the results of risky sexual behaviors (Braithwaite et al, 2009). Male adolescents acquire HIV through male-to-male sexual contacts – 49 percent of reported cases (Braithwaite et al, 2009). Injection drug use and at-risk heterosexual contacts are the second and third most frequent modes of HIV transmission in the U.S. youth, accordingly (Braithwaite et al, 2009). The presence of sexually transmitted diseases increases the chances of getting HIV (Braithwaite et al, 2009).
Racial and ethnic disparities in HIV-related care are well-documented: Stone (2004) writes that, due to the complex social and cultural legacy of minority individuals in America, they are less satisfied with the quality of HIV care and have fewer chances to obtain high-quality antiretroviral therapy. These results were previously supported by Shapiro et al (1999), who claimed that access to HIV care in minority groups was suboptimal: individuals of African-American and Hispanic origin, women, and uninsured individuals reported less desirable patterns of HIV care. Why racial and ethnic disparities in HIV care persist is difficult to define. Underrecognition and socioeconomic factors, transmission risk factors, and delayed presentation contribute to the existing racial disparities in HIV epidemiology and HIV-related care (Oramasionwu, Brown, Ryan, Lawson, Hunter & Frei, 2009). State policies have the potential to reduce ethnic and racial disparities in pharmaceutical access to HIV-related care (Morin et al, 2002).
Not all states realize and acknowledge their role in reducing and preventing HIV in adolescents. In 2008, 12,462 males and 3,301 women in Ohio were living with a diagnosis of HIV (Ohio Department of Health, 2009). 4% of HIV-infected individuals were 15-24 years old (Ohio Department of Health, 2009). 49% of HIV-infected individuals in Ohio were of white non-Hispanic origin (Ohio Department of Health, 2009). In 2008, 44% of those living with HIV were African-Americans (Ohio Department of Health, 2009). Statistically, male-to-male sexual contacts remain the most prevalent mode of HIV transmission in Ohio (Ohio Department of Health, 2008). In this sense, the picture of HIV epidemiology in Ohio reflects the main trends in the national epidemiology of HIV. However, unlike 48 states, Ohio turned down federal money aimed to reduce and prevent HIV infections in adolescents (Turner, 2007). Ohio officials claimed that they would not accept the $1.25 million from the Centers for Disease Control and Prevention, since they did not have an HIV prevention program and staff needed to use the money wisely (Turner, 2007). In the meantime, Cuyahoga Country hits the record of new HIV/AIDS cases, whose number rose sharply from 187 in 2005 to 239 in 2007 (Turner, 2007). In 2006 alone, 227 new cases of HIV were diagnosed, and most of them were in Cleveland (Turner, 2007). “Chlamydia and gonorrhea caseloads are high among Cuyahoga County youth, but as alarming are the 19 cases, ages 15-19, found to be HIV-positive” (Turner, 2007). Unprotected sex remains the main risk factor for HIV in adolescents (Turner, 2007). Complex preventive strategies could help to reduce the risks of HIV transmission in adolescent populations.
How to prevent HIV and AIDS in adolescents is a difficult question. Lauby et al (2010) explored the efficacy of theater-based prevention strategies delivered in juvenile justice settings. Lauby et al (2010) recognize that, despite a high prevalence of HIV and AIDS in male adolescents, HIV prevention interventions targeting these high-risk populations are but few. The sample included young males aged 12-18, of African-American origin, from two different juvenile justice facilities in Philadelphia (Lauby et al, 2010). Following a complex theater-based intervention, all participants demonstrated better knowledge of HIV and its risk factors (Lauby et al, 2010). The discussed intervention improved respondents’ attitudes toward people with HIV and HIV testing (Lauby et al, 2010). Theater-based prevention interventions can become a relevant source of knowledge about HIV and its risks for adolescents (Lauby et al, 2010). This strategy has the potential to become an effective measure of primary prevention in community settings. However, primary prevention alone cannot lead communities to the desired health outcomes. The role of the community nurse is to help reduce prevalence, incidence, and possible complications of HIV through primary, secondary, and tertiary prevention strategies (Clemen-Stone, McGuire & Eigsti, 2002).
Community nurses cannot prevent the incidence and spread of HIV unless they develop a continuum of preventive services (Clemen-Stone et al, 2002). Here, primary prevention is the key goal (Clemen-Stone et al, 2002). Community nurses must develop community-specific prevention efforts that meet the needs of these communities and involve community providers and organizations in the provision of preventive services (Clemen-Stone et al, 2002). Primary prevention is essentially about preventing transmission of HIV/AIDS when community nurses identify at-risk populations and work with them to change and improve their risky behaviors (Clemen-Stone et al, 2002). Education remains the basic element of primary prevention; however, community nurses must ensure that education is population-specific and developmentally appropriate (Clemen-Stone et al, 2002). In the case of adolescents, theater-based interventions discussed by Lauby et al (2010) could become an effective, entertaining, informative, and educating element of primary prevention. These theater-based interventions could teach adolescents the value of abstinence or instruct them on how to use condoms properly.
Secondary prevention focuses on timely diagnosis and treatment of sexually transmitted diseases and HIV (Clemen-Stone et al, 2002). The goals of secondary prevention are to manage infections, promote healthy behaviors and habits, prevent transmission of STDs and HIV to others, and prevent other, opportunistic infections (Clemen-Stone et al, 2002). Community nurses must (a) inform adolescents that unprotected sex is not safe in any circumstances and (b) notify and inform partners of HIV-infected persons of the need for testing and diagnosis (Clemen-Stone et al, 2002). Client and provider referrals can facilitate early diagnosis and treatment of HIV in adolescents (Clemen-Stone et al, 2002). Drug treatment programs will add value to secondary prevention strategies in community nursing care. Effective control programs must be developed, to reduce and prevent the risks of transmission (Clemen-Stone et al, 2002).
Tertiary prevention focuses on rehabilitation and helps to preserve the quality of life and wellbeing in adolescents living with HIV. At this stage of prevention, the community nurse’s main task is to provide supportive care and delay the development of AIDS (Clemen-Stone et al, 2002). Ideal tertiary interventions prevent unhealthy behaviors that increase the risks of other STDs and opportunistic infections and speed up the progression of HIV to AIDS (Clemen-Stone et al, 2002). Tertiary prevention in HIV-infected adolescents must be focused on strengthening their immune systems (Clemen-Stone et al, 2002). Community nurses must engage in collaborative activities which guarantee access of HIV-infected adolescents to quality pharmacological treatment and promote healthy behaviors.
The Human Immunodeficiency Virus (HIV) poses a serious threat to community health. Adolescents are particularly vulnerable to the risks of HIV and AIDS. The main goals of Healthy People 2020 are to prevent transmission of HIV and reduce HIV-related health disparities in the U.S. The role of the community nurse is to help reduce the incidence and complications of HIV through primary, secondary, and tertiary prevention strategies. Education is the main element of primary prevention; it should be population-specific and developmentally appropriate. Secondary prevention covers timely diagnosis and treatment of HIV, to prevent its progression to AIDS. Tertiary prevention focuses on rehabilitation and helps to preserve the quality of life and wellbeing in HIV-infected adolescents. Community nurses must engage in collaborative activities which guarantee access of HIV-infected adolescents to quality pharmacological treatment and promote healthy behaviors.
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