Ending the HIV/AIDS Epidemic by Focusing on the Ethnic/Minority Groups
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Table of Contents
The Burden of HIV/AIDS among the Racial/Ethnic Minorities in the U.S.A.. 4
HIV Epidemiology and Prevalence in the United States. 5
HIV among the Young African Americans and Latinos Adults in the District of Columbia. 6
Overrepresentation of Racial and Ethnic Minorities in the New HIV Diagnoses in the United States 7
Measures on Prevention of HIV/AIDS and the Role of a Nurse in Ending the Epidemic. 8
Introduction
Amidst the fast-paced evolution of sectors across the globe, particularly the healthcare sector, some issues are deterring the realization of development goals. Human Immuno-deficiency virus (HIV) and Acquired Immunodeficiency Syndrome (HIV/AIDS) is a virus that has existed for over four decades now on the global platform. Collaborated efforts and initiatives by different stakeholders in the healthcare sectors have increasingly risen recently to combat the effects of the HIV epidemic. Despite the convergent global attempts, we have seen a decline and not wiping off HIV and its associated AIDS syndrome (Pharris, 2017). Therefore, taking stepwise measures on a population or geographical region primarily affected by the epidemic can be instrumental in making baby steps towards mitigation and ending the HIV/AIDS epidemic.
This article takes a focus on describing HIV/AIDS from a pathophysiological perspective. Also, its global burden and a focus on its epidemiological facts in the United States will be provided. Further, there is an in-depth focus on its prevalence among the minority groups across the U.S., especially among the young African Americans and Latinos teens and adults in the District of Columbia. By doing so, I believe that such statistical data will facilitate the identification of the gaps that ought to be closed through public health interventions. We must end the HIV/AIDS epidemic due to its associated significant morbidity and mortality rates, financial costs, its effect on the quality of life, and the implications on the national and global economy. Finally, we will focus on the role of a nurse in the prevention and management of HIV/AIDS in the United States, more so among the most affected minority groups.
The Burden of HIV/AIDS among the Racial/Ethnic Minorities in the U.S.A
Overview of HIV/AIDS
Human Immuno-deficiency virus (HIV) is the viral infection causing Acquired Immunodeficiency Syndrome (AIDS). The virus comprises the immune system of humans leading to a syndrome that reduces the ability of the immune cells to attack foreign pathogens in the form of antigens. There are three main stages of HIV infection that cause full-blown AIDS manifestation. The acute infection, clinical latency, and acquired immunodeficiency syndrome.
The acute infection stage lasts between two to four weeks following exposure to the virus; either acute HIV, primary HIV or acute retroviral syndrome virus. During this stage, the predominant systemic clinical manifestations include fever and weight loss; central nervous system manifestations such as malaise, headache, and neuropathy; lymphadenopathy; pharyngitis; mouth and oesophagal sores; myalgia; skin rash; nausea and vomiting; and liver and spleen enlargement (Falutz, 2016). Clinical latency stage is mainly the asymptomatic stage of HIV which lasts from between three up to twenty years, and averages eight years without medical intervention. The initial stages are characterized by few or no symptoms. As it progresses, individuals manifest with gastrointestinal problems, fever, and weight loss—over 50% of the affected patients present with persistent generalized lymphadenopathy.
Acquired immunodeficiency syndrome is the final stage; most of the CD4 T-lymphocyte cells have already been destroyed, causing an alternative increase in the CD8 T-lymphocytes. Confirmatory diagnosis of AIDS indicates a CD4 T-lymphocyte count of below 200cells/mm3 (Falutz, 2016). The main clinical manifestations of AID include encephalitis, meningitis, retinitis, pneumocystis pneumonia, tuberculosis affecting most organs, lung tumors, skin tumors, esophagitis, chronic diarrhea, and gastrointestinal tumors. At this stage, opportunistic infections are common due to immunosuppression, thus leading to an invasion of viral-induced cancers such as Kaposi’s Sarcoma and lymphomas.
The spread of the disease is mainly through sexual contact, exposure to infected body fluids such as blood transfusion, and sharing of cutting tools, and through vertical transmission. Among the primary prevention strategies are the use of protection during sex, utilization of pre-exposure prophylaxis (PrEP), avoiding sharing of sharp piercing instruments and cutting tools, and voluntary medical male circumcision.
HIV Epidemiology and Prevalence in the United States
By the end of 2018, approximately 37.9 million people were living with HIV across the globe. During the same year, the number of new infection cases was 1.7 million and 770,000 million deaths were recorded due to AIDS-related illnesses (UNAIDS, n.d.). According to estimated statistics, 74.9 million people have been infected by HIV since the epidemic was reported. Among these cases, 32 million cases of mortality were reported by the end of 2018. 37.9 million people were reportedly living with HIV/AIDS in 2018 with 1.7 million of them being children below 15 years and the rest being adults. A reduction in new cases of infections and deaths by 40% and 56%, since the peak in 1997 and 2004 respectively was observed. However, a significant number of new HIV cases still exist across the globe of about 1.7 million around the world.
In the United States, itis said that around 1.1 million people living with HIV (Hess et al., 2018). Approximately 14% of these cases do not know about it. Nearly 38,000 preventable new cases of infection are reported in the United States every year. According to the Center for Disease Prevention and Control (CDC), the annual cases of HIV infections plateaued since the year 2013 up to date following five years of substantial decline (2020). The health department attributes the scenario to the inadequate measures reaching the vulnerable regions such as in the South and populations, including African American and Latinos across the United States. The impact of HIV/AIDS widely affects the above racial and minority groups, men having sex with men, bisexuals, and gay men.
HIV among the Young African Americans and Latinos Adults in the District of Columbia
In 2018, the Blacks accounted for 42% of the new HIV cases while the Latinos accounted for 27% of the new HIV diagnoses. Both minority groups constituted 69% of the total new cases despite representing only 33% of the total population. The most affected age groups were the young adults below the age of thirty-five and the adolescents since they accounted for about 56% of new HIV cases in 2017; 35% proportion for those aged between 25-34 years and 21% between 13 to 24 years. Data analyzed revealed that the District of Columbia records the highest rate to HIV incidence compared to the other states (Dasgupta, Oster, Li & Hall, 2016). According to Hess et al., ten of the states in the region contributed to about two-thirds of HIV cases among teens and young adults (2018).
A study by Hess et al. estimated that the incidence of new HIV cases among African Americans to be eight times as compared to native Americans. The Hispanics came second with a three times higher rate than the native Americans (2018). Besides, results from a survey indicate that HIV is a significant public health concern for young adults aged between 18-34 years, more so those belonging to the minority groups.
Overrepresentation of Racial and Ethnic Minorities in the New HIV Diagnoses in the United States
One of the claims put forward to explain the reason for the significantly high incidences of HIV/AIDS cases among the Blacks, especially men having sex with men (MSM) is lack of awareness. A study published in 2015 was conducted between 2008 -2014 to identify the racial and ethnic disparities regarding awareness and HIV infection rates among the young Black men having sex with men (Wejnert et al., 2016). The survey, through analysis of the National HIV Behavioral Surveillance data, used Poisson models to test racial disparities concerning HIV prevalence, HIV awareness, and their sexual behaviors. Results from data analysis indicated that 26% of the tested Black men having sex with men aged 18-24 years in 2014, were positive. However, only 3% of the White MSM aged between 18-24 years included in the survey tested HIV positive.
Behavioral risk factors such as opioid use among the minority groups are also attributed to increased HIV contraction. Another study conducted in Atlanta by Hernández-Romieu et al. reports that Black men having sex with men are more likely to report having multiple partners in their sexual partner pool. The results imply that they end up reporting higher HIV prevalence and transmission compared to other racial groups (2015). Low engagement in HIV care and lower socio-economical statuses attributed to poverty among the minority groups, especially among the Blacks MSM are some of the factors that were found to increase HIV transmission (Goodreau et al., 2017; Huamani, Metch, Broder & Andrasik, 2019). A 14-year longitudinal study was done to assess the HIV/AIDS risk behaviors among the youth after leaving detention recruited 1829 youth between 1995 and 1998. They were reinterviewed up to 11 times and risky sex behaviors for HIV/ AIDS assessed. Results indicated that African American males had 2.56 times the odds of having more than one sexual partner compared to their non-Hispanic white males. Hispanic males had 1.63 times the odds of having multiple sexual partners compared to the non-Hispanic males (Abram, Stokes, Welty, Aaby & Teplin, 2017). Based on the HIV care Continuum, African Americans and those in the minority groups have relatively low rates of linkage to HIV medical care, retention in care, and virologic suppression (Spach, 2020).
Measures on Prevention of HIV/AIDS and the Role of a Nurse in Ending the Epidemic
The United Nations declared war against the global HIV/AIDS epidemic by the year 2030 (Assembly, 2016). A strategy developed by the United Nations called the 90-90-90 plan focuses on increasing the percentage of the infected population to be fully aware of their status by 90%, over 90% of those diagnosed with HIV/AIDS to have access to antiretroviral therapy, and 90% of those on antiretroviral therapy to have zero viral load detection by this year, 2020 (Stover et al., 2016). According to Fauci, Redfield, Sigounas, Weahkee, & Giroir (2019 the United States president, in 2019 addressed the nation and declared his organizational goal to end the HIV epidemic within the next ten years.
Regarding the collaborative measures by the governments, and global health agencies, healthcare providers are the most critical stakeholders in fostering HIV epidemic mitigation strategies at the community level. Modification of the risk factors that increase HIV prevalence is essential. Nurses, as frontline healthcare professionals should adopt control as one prong of preventing the spread of HIV/AIDS. Risky behaviors among the vulnerable groups such as the African Americans and Latinos have increasingly contributed to the increased incidence, transmission, and prevalence of HIV/AIDS. Nurses ought to collaborate with stakeholders in healthcare settings and in the community, level including public health officers, community members, and community health workers to increase awareness and education in the focused groups of the population. Empowerment through sex education for then adolescents, youth, and young adults, especially among men having sex with men is vital in breaking the chain of transmission. Integration of sex education programs in educational and religious institutions is also critical in reducing the effects of HIV/AIDS. Cultural competency ought to be considered and more recruitment of more minority healthcare professionals into the HIV development taskforce.
Conclusion
HIV/AIDS epidemic remains a significant public health concern across the globe. Despite the decline in the prevalence and incidence of global HIV/AIDS cases, there exist geographical and ethnic/racial disparities. In the United States, there exists a disproportionate burden of HIV is often evident in the racial/ethical minority groups. The African Americans record significant numbers and rates of people with HIV in the United States with the Hispanics recording the second-highest HIV prevalence rate. Reduction of the global and federal goals is reduced health disparities and inequalities associated with HIV/AIDS. In general, minority groups have lower rates of HIV knowledge and empowerment compared to native Whites. Concerning the HIV Care Continuum, Blacks have relatively lower rates of linkage to medical care and viral suppression (Spach, 2020). Therefore, reducing such disparities through risk environmental model paradigm and providing health education by nurses in collaboration with stakeholders in the community will improve the outcomes.
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