Assignment: Benchmark Policy Brief

 Research public health issues on the “Climate Change” or “Topics and Issues” pages of the American Public Health Association (APHA) website. Investigate a public health issue related to an environmental issue within the U.S. health care delivery system and examine its effect on a specific population.

Write a 750-1,000-word policy brief that summarizes the issue, explains the effect on the population, and proposes a solution to the issue.

Follow this outline when writing the policy brief:

1. Describe the policy health issue. Include the following information: (a) what population is affected, (b) at what level does it occur (local, state, or national), and (c) evidence about the issues supported by resources.
2. Create a problem statement.
3. Provide suggestions for addressing the health issue caused by the current policy. Describe what steps are required to initiate policy change. Include necessary stakeholders (government officials, administrator) and budget or funding considerations, if applicable.
4. Discuss the impact on the health care delivery system.

Include three peer-reviewed sources and two other sources to support the policy brief.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Course Resources if you need assistance.

Benchmark Information

Registered Nurse to Bachelor of Science in Nursing

The benchmark assesses the following competencies:

1.4 Participate in health care policy development to influence nursing practice and health care.

Epidemiology is the scientific study of how frequently diseases occur in different groups of people and why. It is based on two fundamental assumptions. Firstly, it assumes the occurrence of the disease is not random because several factors concomitantly influence the likelihood of developing the disease (Stover et al., 2021). Further, it assumes the study of populations facilitates the recognition of the causes and preventive factors analogous with the disease. Communicable diseases refer to infectious diseases caused by different microorganisms such as bacteria, viruses, fungus, and parasites that can be spread directly or indirectly from one individual to another. Many infectious diseases can be transmitted via bites from insects, while others are caused by ingesting contaminated substances such as food or fluids. Although several infectious diseases pose serious health risks to communities, HIV can never be underestimated. The purpose of this paper is to discuss HIV and apply epidemiology and nursing research concepts to this communicable disease.

Description of HIV as Chosen Communicable Disease

HIV is a retrovirus that destroys cells of the human immune system (mainly CD4-positive T-cells and macrophages), which are the cellular immune system’s critical components, and kills or impairs their role. Infection with this virus results from the progressive depletion of the immune system, leading to immunodeficiency (UNAIDS, 2021). The Human Immunodeficiency Virus comprises two strands of RNA, 15 types of viral proteins, and a few proteins from the last host cell it infected, all surrounded by a lipid bilayer membrane. There are two categories of HIV, HIV-1 and HIV-2. HIV-1 can be found worldwide, but HIV-2 is almost exclusively limited to West Africa. HIV-1 is transmitted more easily than HIV-2(UNAIDS, 2021). The advanced level of HIV infection is acquired immunodeficiency syndrome (AIDS). AIDS is determined by developing certain malignancies, conditions, or other acute continuing clinical indications. HIV-1 infection progresses more rapidly to AIDS compared to HIV-2.

Causes of HIV

A virus causes HIV through sexual contact or blood. In addition, transmission can occur from mother to child during pregnancy, childbirth, or breastfeeding. When the virus enters the blood, it destroys the white cells that provide the body with the ability to fight infections and disease (UNAIDS, 2021).

Symptoms

The symptom of HIV varies and is determined by the phases of infection. Several people infected with HIV may manifest flu-like symptoms a few weeks after the entry of the virus. The likely symptoms at the acute stage may include fever, headache, skin rash, sore throat, and painful mouth sore. Similarly, swollen lymph glands, especially on the neck, muscle aches, joint pains, and diarrhea may manifest. In addition, the person could also manifest coughs, weight loss, and night sweats (UNAIDS, 2021). As the pathogen mutates in the blood and destroys the white cells at the symptomatic stage, the following symptoms may manifest Pneumonia, herpes zoster, thrush or oral yeast infection, fatigue, and fever. Furthermore, when the virus progresses to the stage of AIDS, the mentioned symptoms would manifest to be persistent and severe (UNAIDS, 2021).

Mode of Transmission

The predominant mode of HIV transmission is through unprotected sexual contact with an infected partner. In addition, exposure of broken skin or wound to infected blood or body fluids. Similarly, transfusion with HIV-infected blood is another avenue for transmission (Stover et al., 2021). Moreover, when an individual is injected with contaminated objects like needles and unsterilized syringes or razorblades, the virus is likely to be transmitted. Furthermore, transmission can also occur from mother to child during pregnancy, birth, or breastfeeding (UNAIDS, 2021).

Complications

People infected with HIV who do not get proper treatment for HIV/AIDS develop a wasting syndrome accompanied by diarrhea, fever, and chronic weakness. In addition, individuals are likely to develop neurological complications as the virus reduces mental functioning. The difficulty includes kidney disease, such as the inflammation of kidney filters that remove excess fluid and waste from the blood to the urine. Similarly, there is the liver complication (UNAIDS, 2021).The other common infectious complications related to or due to HIV comprise Pneumonia that causes severe illness. The difficulty of thrush or candidiasis causes inflammation on various body parts, i.e., the mouth, tongue, and esophagus. Similarly, the other problematic condition is Tuberculosis, especially in developing countries(Mahy et al., 2021).

Treatment              

HIV has no cure but can be controlled through antiretroviral therapy. The treatment entails taking medicine that lessens the viral load in the blood. The medicine for HIV therapy is called antiretroviral (UNAIDS, 2021).The treatment involves a combination of everyday medications that prevent the virus from multiplying. The treatment aids protect the CD4 cells, keeping the immune system strong enough to combat infection and disease. The ART lowers the viral load and reduces the chance for transmissions from one person to another ((Mahy et al., 2021)

Demographic- Prevalence

The global prevalence of HIV, according to UNAIDS (2021), estimates that about thirty-eight million people living with HIV. Women accounted for fifty-three percent of the number, while men accounted for forty-seven percent. Furthermore, two million are children between zero to nineteen years of age. In addition, data indicate that women aged fifteen years up to twenty-four years globally acquire HIV. Furthermore, Sub-Saharan females account for sixty-three percent of the newly acquired HIV infection. Women accounted for fifty –three percent. Similarly, in 2020, 1.5 million people contracted HIV globally (UNAIDS, 2021).

According to the UNAIDS report, the most affected populace with HIV is from developing countries. For instance, in 2020, east and southern African countries had twenty-seven million people infected with HIV, accounting for fifty-five percent of global infection. Moreover, Asia and Pacific regions had six million people infected, accounting for fifteen percent of global infection. In addition, western and central Africa had five million infected, accounting for thirteen percent. Moreover, North America and Central Europe had two million, accounting for six percent of the global infection prevalence (UNAIDS, 2021).

Reporting of HIV

The primary object for reporting is for public health authorities to know where several diseases are found in a population. The information helps them take steps to mitigate the spread of infectious diseases and safeguard the community’s health. Further, it ensures linkage of care for any newly infected patients or continuation of care for earlier diagnosed patients(Stover et al., 2021). Moreover, timely monitoring presents trends in the epidemic and secures proper funding for local treatment and prevention services.HIV is a reportable condition that medical practitioners and pathology services must notify within five days of diagnosis to the HIV is reported only to the HIV/AIDS Surveillance Program at the Department of Public Health.

Determinants of Health and Explanation of How Determinants Contribute to Disease Development

Social health factors are the conditions in which people are born, grow, live, work and age. The social determinant includes factors like socioeconomic status, education, neighborhood, physical environment, employment, social support networks, and access to health care(Stover et al., 2021) The social factors of health can influence a person’s likelihood of acquiring HIV through influences on improper behavior, limited access to preventive measures, and limited access to healthcare providers or testing sites.

Studies show that abuse drugs such as alcohol, cocaine, marijuana have exacerbated the risk of HIV infection. Similarly, the use of drugs leads to confinement. The individuals under detention are reported to be engaging in unprotected sex leading to a high rate of HIV infection. Further, the social-economic status has contributed to the prevalence of HIV. The economically poor are more likely to get into unwarranted behaviors, e.g., indulging in commercial sex, thus risking and enhancing the infection of the virus (Mahy et al., 2021). Economically vulnerable women experience the scarcity of health-related resources in poor, under-served communities or villages where access to health care and condoms are not readily available(Mahy et al., 2021). These compounding social health determinants extrapolate the prevalence and the risk of acquiring the virus.

The Epidemiologic Triangle

The Epidemiologic Triangle is a tool that researchers employ in addressing the three constituents that contribute to the spread of infections or disease. The triple components comprise an external agent, a susceptible host, and an environment that brings the agent and host together (Mahy et al., 2021).The triangulation of HIV (causative agent) refers to factors and attributes of the virus that concomitantly aids its infection and spread on the host. Firstly, the nature of the subtype of the HIV Virus determines the extent of infection and spread. Studies show that HIV-I is easily transmitted due to its biological and chemical characteristics. To underscore, HIV-1 RT is a heterodimer composed of p66 and p51 subunits, with p66 harboring two functional, active sites: an N-terminal RNA- and DNA-dependent DNA polymerase and a C-terminal RNase H that digests the RNA component of RNA–DNA hybrids (De Almeida et al., 2021). Due to its nature, HIV -1, therefore, binds more efficiently and faster than HIV 2 with the receptor molecule CD4 on the cell surface.; thus having a higher capability to infect and spread rapidly. Similarly, the other exacerbating factors include having a sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhea, and bacterial vaginosis that enhance chances for infection.

The host triangulation characterizes the host (human) factors as those that help enhance infection and spread the virus. The factors include having unprotected sex, having a frequent change of partners or having sexual activity for financial gain, peer pressure, drug and substance abuse (Hershow et al., 2019). These behaviors aid in enhancing HIV infection and spread. Similarly, urban health studies have found that poverty and unemployment, vacant buildings, and high crime rates are concomitant with an increased risk of HIV infection. The Social economic factors such as lack of access to care, discrimination, stigma, homophobia, and poverty enhance higher rates of HIV infection. Studies from cosmopolitan and urban areas indicate that poverty, unemployment, and high crime rates increase the risk of HIV infection and spread (Hershow et al., 2019). In addition, viral load increases in the infected occur for reasons such as not taking antiretroviral medication consistently due to lack of access to ART.

Special Consideration

There are special considerations or notifications for the community regarding the triangulation of HIV. Communities affected by HIV usually do risky behaviors, including sexual activities without protection and sharing paraphernalia that contribute to HIV infection. HIV education can aid learners in schools and the community develop and maintain safer behaviors and reduce stigma and discrimination towards people affected by and living with HIV (Hershow et al., 2019).

Role of the Community Health Nurse and Importance of Demographic Data

Nurses play vital roles in educating patients about HIV, providing support for treatment adherence, and assisting with navigation of care delivery. APRNs, further, are positioned to provide ART directly, consistent with their state practice authority.The community health nurse has professional technical skills and knowledge that the community populace may not have; thus, the nurse has the role in ensuring the quality of community-based care(Stover et al., 2021). They form a significant component in delivering quality HIV services, including counseling, adherence support, development of a referral framework, and dissemination of information. They also have the role of reporting and HIV data collection.

Demographics are essential since they offer an exhaustive comprehension of a population’s various features. The provided information is particularly vital to government organizations and institutions for making crucial policy decisions concerning the people(Stover et al., 2021). Similarly, demographics data is critical as it gives the health authorities andpopulace information they need to strategies and implements future investments and services; data from sources such as the CDC and the US Census aids in determining where assistance programs need to be directed (UNAIDS, 2021)

National Agency or Organization That Works to Addresses Communicable Disease

The USAID is one of the major federal agencies that implement the PEPFAR core mandate. The USAID’s Office of HIV/AIDS reinforces country-led efforts to combat the complex challenges of HIV in over fifty countries around the globe. The agency avails global leadership in developing projects and plans of actions that amplify impact. Similarly, it reinforces country-led programs and policies while at the same time administering USAID’s elaborate health and development skills and particularized HIV/AIDS technical capability(Stover et al., 2021). Further, the organization applies research, technology, and change to encourage cost-effective, sustainable, and judicious integrated HIV/AIDS interventions.

Global Implication of HIV

Notwithstanding the existence of treatment that can manage and mitigate the progression of HIV viral transmission, the virus remains a major leading cause of death and a health risk to millions globally. HIV is non-endemic; it is widespread globally. Different countries have put various strategies to mitigate the infection surge among their population. Techniques like the use of male and female condoms are encouraged by various governments. Further, voluntary medical male circumcision is agitated across the globe to minimize the chances of infection. (UNAIDS, 2021).Moreover, many countries use antiretroviral drugs to prevent mother-to-child transmission, pre-exposure prophylaxis, post-exposure prophylaxis, and treatment as prevention. Similarly, sex and reproductive health services are used to inform the population on the crucial knowledge that helps reduce infection of the virus (Stover et al., 2021).

Conclusion

HIV is a retrovirus that destroys cells of the human immune system, specifically the CD4-positive T-cells and macrophages. There are two types of HIV, namely HIV-1 and HIV-2. HIV-1 can be found worldwide. In addition, the infection is non-endemic but widely spread. Further, it is caused by a virus that enters the blood and impairs the white cells. Moreover, the primary mode of HIV transmission is through contact with infected blood body fluids. In addition, people infected with HIV who do not get proper medication for HIV/AIDS develop diarrhea, fever, and chronic weakness. In addition, they are likely to develop complications like neurological malfunction, kidney, and liver, among others. UNAIDS 2021 report reveals that about thirty-eight million people live with HIV, of whom women are the majority with infection. Similarly, regionally, the Sub-Saharan countries lead with an infection of about twenty-seven million, accounting for 53% of the world infection as of 2020. Moreover, the condition is modifiable to the health authorities to help mitigate the spread of infectious diseases and safeguard the community’s health.

References

De Almeida, S. M., Rotta, I., Tang, B., Vaida, F., Letendre, S., Ellis, R. J., & HNRC Group. (2021). IgG intrathecal synthesis in HIV-associated neurocognitive disorder (HAND) according to the HIV-1 subtypes and pattern of HIV RNA in CNS and plasma compartments. Journal of Neuroimmunology, 355, 577542. https://doi.org/10.1016/j.jneuroim.2021.577542

Hershow, R. B., Gonzalez, M., Costenbader, E., Zule, W., Golin, C., & Brinkley-Rubinstein, L. (2019). Medical providers and harm reduction view on pre-exposure prophylaxis for HIV prevention among people who inject drugs. AIDS Education and Prevention, 31(4), 363-379. https://doi.org/10.1521/aeap.2019.31.4.363

Mahy, M. I., Sabin, K. M., Feizzadeh, A., & Wanyeki, I. (2021). Progress towards 2020 global HIV impact and treatment targets. Journal of the International AIDS Society, 24, e25779. https://doi.org/10.1002/jia2.25779

Stover, J., Glaubius, R., Kassanjee, R., & Dugdale, C. M. (2021). Updates to the Spectrum/AIM model for the UNAIDS 2020 HIV estimates. Journal of the International AIDS Society, 24, e25778. https://doi.org/10.1002/jia2.25778

UNAIDS (2021) epidemiological estimates.https://aidsinfo.unaids.org