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Human Immunodeficiency Virus Research in Nursing Essay

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Updated: Jul 24th, 2021

Introduction

Human Immunodeficiency Virus (HIV) remains one of the main challenges of global public health. “Once considered a lethal diagnosis, HIV infection came to be seen as a chronic, manageable condition with the discovery of antiretroviral therapies in the mid-1990s” (Hammack et al., 2018). Recently, several recent studies have claimed that diagnoses of HIV have declined in the last decade in the United States. Nonetheless, increases in HIV diagnosis are affected by test rates, delays in diagnoses, and infection levels, and should, therefore, be reviewed following current estimates of HIV incidence (Hall et al. 2017).

For this review, articles were chosen with keywords including “HIV,” “USA,” and “tendency,” or “current.” These keywords were then combined, and a search strategy was completed, including databases such as PLOS and JAIDS. Articles from the past four years were included in this search and included studies as well as systemic reviews and meta-analyses. The themes in this synthesis are HIV trends in the US, condom use for HIV prevention, mortality of HIV-infected individuals, knowledge of PrEP, and HIV testing.

Discussion of the Theoretical and Empirical Literature

Assessment and Screening

Auerbach, Kinsky, Brown, and Charles, (2015) examined PrEP’s acceptability and feasibility among women at risk for HIV in the US. The setting for this evaluation was a focus group of 144 at-risk females in six US cities. Although only around 10% of the women were familiar with PrEP before the study, they expressed keen interest in using it. A majority of participants stated concern that they have not been familiar with such HIV prevention method before, as not even their doctors informed them about PrEP existence. Hence, the study concluded that US women view PrEP as an essential prevention option; however, there is a lack of informing among women about the availability of such a protection method.

A study by Coghill, Pfeiffer, Shiels and Engels (2017) investigated excess mortality among HIV-infected individuals who have cancer, using quantitative and qualitative data analysis. The study revealed that “overall mortality in patients with both HIV and cancer was significantly higher than expected based on mortality rates for each disease separately” (Coghil et al. 2017). One of the key messages in this article were excess mortality of patients with both diagnoses was the most common for individuals below 50. Furthermore, it was found that race and cancer type does affect the mortality rates of young males with HIV. “The study concluded that death rates of patients with both HIV and cancer was significantly higher than for each disease separately” (Coghil et al. 2017).

Hall et al. (2017) examined the recent progress toward reducing HIV among Americans using a quantitative approach. The study showed that there had been a decrease from about 50,000 HIV infected to 36,000 between blacks and Latinos from 2008 to 2013 (Hall et al. 2017). In addition, a small reduction of HIV affected was revealed among men who have sex with men (MSM). The authors also note that “more work needs to be done to alleviate the possible reasons that HIV transmission continues at high rates among MSM, including […] s lack of substantial uptake of pre-exposure prophylaxis (PrEP)” (Hall et al. 2017).

Hammack, Meyer, Krueger, Lightfoot, & Frost (2018) examined HIV testing, use, familiarity, and attitudes toward pre-exposure prophylaxis (PrEP) among HIV-negative gay and bisexual men in the United States. The setting for this evaluation was data from a national probability sample of lesbians, gay men, and bisexuals in three age cohorts (18–25, 34–41, and 52–59 years old) from 50 US states. It was determined that “only about 50% of men in the younger and older cohorts reporting familiarity with PrEP” (Hammack et al. 2018). The authors note such percentage of PrEP awareness is low. Limitations of this review include the lack of efforts done to educate gay and bisexual men about possible HIV risks. Overall, “the study concluded that most men potentially at risk for HIV do not meet CDC guidelines for testing, and PrEP use continues to be minimal” (Hammack et al. 2018).

An article by Smith, Herbst, Zhang and Rose (2015) discussed male condom effectiveness during anal sex among MSM groups. The analysis estimated 70% effectiveness of HIV prevention with consistent condom use in any form of anal sex. One imperative finding in this article was that “inconsistent (“sometimes”) condom use with HIV-positive male partners over months to years offers minimal or no protection” (Smith et al. 2015). In addition, the authors revealed that only 16% of MSM always use a condom during sex with partners of any HIV status (Smith et al. 2015). It is possible to note that there have been limitations in this study, though, including a lack of validated information about the status or treatment of sex partners.

PrEP Familiarity and Use

PrEP awareness in the US has been primarily focused on the MSM population, who still face the most significant risk of HIV infection in the world. However, the following studies note the importance of including other groups in the broad introduction of PrEP. According to Auerbach et al. (2015) “As HIV transmission continues to occur among women, it is imperative to make effective HIV prevention strategies available to them—particularly those that women can control (unlike the use of male condoms, for example)”. The authors also mention that women at high HIV risk are critical in rolling up PrEP, as they view it as a reliable HIV protection option and might take it themselves or recommend it to others.

Education interventions on PrEP for not-targeted male groups are also an essential factor in HIV reduction. Hammack et al., in their article state, middle-aged men are more familiar with PrEP than younger (18-29) and older (50-59) males. The authors also suggest that “efforts to educate gay and bisexual men about HIV risk and prevention need to be reinvigorated and expanded to include non-gay-identified and non-urban men.” Thus, according to the findings, it is imperative to educate women, non-gay-identified, and non-urban males about PrEP.

HIV Tendencies and Future Directions

A study completed by Hall et al. (2017), evaluated factors, which contribute to the reduction of HIV incidents among various groups. The authors mark a significant reduction in HIV transmission was mainly heterosexual individuals. However, as stated by Hall et al. (2017), “further progress is dependent on effectively reducing HIV incidence among MSM, among whom the majority of new infections occur.” It is also mentioned that in order to decrease HIV rates, there is a need to accelerate access to PrEP and testing. It is possible to note that, as stated by Coghill et al. (2017), “the HIV population in the United States is aging over time, increasing the likelihood that HIV-infected persons will live into their 50s and 60s”. The author stated that there might have been mistakes in studies on HIV reduction rates.

Furthermore, there is a lack of individuals who have ever been tested oh HIV or used PrEP. According to Hammack (2015), 25% of MSM men aged from 18-29 have never been tested on HIV; half of gay and bisexual males in this cohort are familiar with PrEP. Besides it, there are other prevention methods used by the MSM group, namely, condoms. Smith et al. (2015) suggest that there is “strong but partial effectiveness for consistent condom use, minimal effectiveness for inconsistent condom use, and low rates of consistent condom use over 1–2 years”. In addition, the author highlights the need to intensify the education of HIV-negative MSM and assist them in evaluating risks of HIV acquisition. Both of the studies confirm there is an urgency to provide all MSM groups not only with access to testing but also with information on the protection advancements and options.

Summary

The synthesis of literature supported the need for proper HIV and PrEP education among MSM, women, non-gay-identified, and non-urban males regardless of HIV status. The articles also prove the rise of understanding of the importance of preventive work with men who have sex with men. It is identified that a deficiency in knowledge of such HIV prevention methods negatively impacts people, resulting in the continuous spread of the virus. In accordance with the used materials, problems with HIV prevention certainly exist; however, much work is being done, the result of which will be a significant reduction in HIV-positives. Various guidelines are supported in this review and will be utilized in the creation, and implementation of a validated knowledge assessment tool, as well as the creation and implementation of the educational intervention, offered to high-risk groups.

References

Auerbach, J. D., Kinsky, S., Brown, G., & Charles, V. (2015). Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care and STDs, 29(2), 102-110.

Coghill, A. E., Pfeiffer, R. M., Shiels, M. S., & Engels, E. A. (2017). Excess mortality among HIV-infected individuals with cancer in the United States. Cancer Epidemiology and Prevention Biomarkers, 26(7), 1027-1033.

Hall, H. I., Song, R., Tang, T., An, Q., Prejean, J., Dietz, P & Mermin, J. (2017). JMIR Public Health and Surveillance, 3(1), e8. Web.

Hammack, P. L., Meyer, I. H., Krueger, E. A., Lightfoot, M., & Frost, D. M. (2018). PloS One, 13(9). Web.

Smith, D. K., Herbst, J. H., Zhang, X., & Rose, C. E. (2015). Condom effectiveness for HIV prevention by consistency of use among men who have sex with men in the United States. JAIDS Journal of Acquired Immune Deficiency Syndromes, 68(3), 337-344.

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