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NUR844 Clinical Care And Treatment Issues In HIV

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  • Course Code: NUR 844
  • University: Duke University
  • Country: United Kingdom

Question:

Discuss community nursing roles in promoting access to health services for key populations at risk of exposure to HIV (men who have sex with men, IV drug users, sex workers, people in prisons, transgender people) to reduce their risk of exposure to HIV.

 

Answer:

Human immune-deficiency virus can be defined as the transmissible organism that participates in infecting the different human bodies through the support from the T-helper cell. The infection is mainly seen to lead a progressive decline in the immune function and subsequently leads to the situation of a state of immune compromise (Boyer et al., 2017). Mainly because of the compromised immune system, individuals who are infected with the virus are seen to become susceptible towards a variety of different types of opportunistic infections that are refereed in healthcare as the AIDs defining illness. In individuals who do not get any treatment, this viral infection often inevitably leads to death. HIV is a form of retrovirus. It is actually an RNA virus and it has the ability for transforming its RNA into the DNA during the replication procedure (Pearson et al., 2015). Due to the rapid replication, it has got the status of a highly variable virus and therefore, it is one of the reasons why it becomes very difficult for developing the vaccine. This retrovirus is indeed very much fragile and therefore they do not survive outside the different host cell environment. This assignment would mainly be focusing on the community nursing principles in effectively handling and reducing risks of HIV among the vulnerable population in the nation.

This infection can affect any individuals who engage in unsafe sex, intercourse with multiple partners, blood transfusions and many others. However, researchers are of the opinion that the prevalence of the disorder has lessened in the general population due to proper health promotion and allocation of resources but have not lessened among the vulnerable population. Therefore, it is extremely important for the nursing professionals working in the communities to identify the vulnerable population and develop interventions that would help them to reduce the risks of them affecting by the disorder (Kim et al., 2016). Researchers are of the opinion that there are some typical groups in the various communities of the nation who are more likely to be diagnosed late, less likely to be engaged with healthcare, accessing of different treatments, adhering to different treatments as well as achieve viral suppression.

 


Rates of the disorder among the aboriginals and non-aboriginal Australians were previously found to be similar at around 4 per 100000 people in the nation but transmission modes are seen to be different with higher rates being more prevalent in the women, people who inject drugs and those who are heterosexual. However, the rates of the newly diagnosed HIV rates in the Aboriginal and the Torres Strait islander population as found in the reports published in 2012-2014 showed that the number of the affected individuals of the native background is higher than that of the non-indigenous population for about 5.9 versus 3.7 per 100000 (Poteat et al., 2015). Another vulnerable population with susceptibility of being affected with the disorder is the asylum seekers. Reports have shown increasing number of asylum seekers with HIV infection being reported in the Darwin of the northern territory. It has shown that the introduction of the HIV screening for those arriving by both and without visa in the nation has increased the number form 18 in 2011 to 2012 to that of 30 in 2012 to 2013. They mainly tend to hide their disorders with the fear of not knowing the acceptation rates of the nation and being unaware about the behaviors that he would receive from others in the new nation where the citizens would be knowing about their disorders (Eldredge et al., 2016) . The fear of stigmatization as well as discrimination in the nation makes them hide their disorders and so they do not seek for any kind of services from healthcares. Therefore, they tend to be one of the most important vulnerable groups that professionals need to care for.

In the nation of Australia, this disorder continues to be the transmitted through the sexual contacts between men. In the year 2013, reports provided by the government had shown that about 70% of the total new HIV infections were seen to be present among the men who had sex with other men. It is seen that this population is highly affected and they need access to the healthcare as well as prevention. They need to remain engaged in care for the reduction of the community viral load and thereby helps in reduction of the number of new infections  as well as different types of HIV related co morbidities. The 2012 Global Men’s Health and Rights Study had found interesting results (McCabe et al., 2016). They have found that men who have sex with men are more vulnerable in encountering barriers for accessing treatment as well as prevention at the different levels. Researchers are of the opinion that at an institutional level or that of the systemic level, men who are seen to have sex with other men can encounter stigma as well as criminalization of homosexuality and even discrimination. Often they feel that they cannot disclose their preferences to that of the healthcare providers with the fear of being judged regarding their sexual behaviors. This results in the leading of the situations where HIV testing often is delayed and there is delay in the accessing of the treatment (Amaro et al., 2016).

 


Another vulnerable population is those people who are seen to inject drugs and are called PWID (people who inject drugs). It is true that although Australian government had published various types of developing and implementation of the harm reduction policies, in reality, evidence based studies have shown that they experience reduced access towards healthcare services and higher incidences of discrimination and poor treatment with the healthcare services. Therefore, they are found to remain exposed to higher risks for the late HIV diagnoses in comparison to men who have higher sex with other men as well as heterosexuals (Palacios et al., 2015). Therefore, the community nursing professionals need to develop proper interventions which should be evidence based and should be helping in reduction of the risks of being affected with the HIV disorder.

Sex workers are seen to be associated with the epidemic of the disorder since the time of the onset and is mainly stated so because of the nature of their rework. Governments have log debated about the advantages as well as the disadvantages of the regulation, prohibition as well as tolerance and prostitution. The majorities of the today’s’ societies represent a “moral” as well as the contradictory objections towards prostitution. There have been debates about the success of the sex industry as the important source of commerce but on the other hand, they are seen to condemn the procedures of earning money through sex (Liamputtong, 2015). Often such debates result in creation of confusion as well as stigmatization about the wok of the sex workers making them stay away from the help seeking behaviors regarding their perceptions that they would be poorly treated and they would be judge regarding their professionals. Hence, the healthcare professionals need to be very careful and need to establish interventions that would help in reduction of the risk with equal participation and compliance with the interventions proposed.

 


It is very important for the community nurses to develop a comprehensive quality health services for the vulnerable population by which they can help the vulnerable individuals to overcome their apprehensive feeling of help seeking behaviors and undertake proper screening and preventing services. A number of important points need to be kept in mind in order to develop most effective services for the vulnerable populations. Proper access to quality and comprehensive healthcare services, effective management and health literacy development of the vulnerable population, HIV voluntary counseling as well as testing services like VCT and others should be ensured (Batcheldor et al., 2015). It is the duty of the community nurses to develop health promotional programs. This service would help in circulating the information about the non-judgmental care services that they would be receiving from the professionals. This would enhance the morale of the individuals of the vulnerable communities and would make them believe that they would receive high quality, sensitive, non-judgmental services from the professionals. Researchers are of the opinion that when inter-personal confidence between the vulnerable groups and that of the community health providers are promoted as well as well-established, there would be hardly any issues that the vulnerable individuals will face in seeking for different preventive and screening services. Effective healthcare providers and counselors need to able to talk frankly about the different sensitive issues that would help in addressing the different real practices  as well as behaviors that would help in making the HIV transmission more likely.

Another most important barrier that the vulnerable populations might face is the ingrained stigma as well as discrimination, which are the constant impediments in the appropriate interactions between the different health providers as well as the vulnerable populations. Therefore, the different researchers who have worked on the issue have emphasized on the building of the stigma free environment in the communities as well as in the healthcare clinics by educating about the disorders not only among the vulnerable individuals but among the other people as well (Baral et al., 2014). When the citizens would get to know about the disorder in details and how it is affecting the quality of health of humans, their stigmatized and judgmental behaviors would stop and the vulnerable population would get the courage to reveal their concerns and no more hide their preferences or issues. This would help in early diagnosis of the disorder that would help in saving the life of many people.

 


It is very important for the community nurses to make the vulnerable communities feel empowered. Studies are of the opinion that when individuals feel empowered, they can participate actively in effective decision-making, take access to healthcare services, and ensure health-seeking behaviors effectively. The care services should be such that the vulnerable populations should be the key designers of their own services that will not “miss the mark” and block access (Denno et al., 2015). The nursing professionals in such situations must learn about the ways for providing services that would be appropriate for the specific groups like that of the transgender along with the reduction of stigmas and discrimination of the healthcare services. All the communities of the vulnerable population should be able to talk openly about the fabric of their lives and the healthcare providers need to be able to listen and mandate (Kelly et al., 2017). The active engagement in the design as well as the provision of the healthcare services is extremely important  for not only for the client comfort but would also help in creation of systems that will accept and actively help the individuals to participate and consider themselves an active part in decision making leading to their empowerment.

 A number of miscellaneous actions need to be taken by the community nurses to make sure that the vulnerable individuals take active participation in the screening programs. They need to, come up with their concerns and development of their health literacy in place of concealing their identity, professions and practices and thereby seek for support and educate themselves about the ways by which they can reduce the risks of getting affected. The community nurses undertaken the health promotion campaigns should spread awareness and educate vulnerable population in a way by which they can establish through different non-judgmental approaches. The drug-abusing individuals who use syringes should be supported and educated them in harm reduction like effective injection techniques, proper access to clean injecting mediums, safe disposal of the equipments. These can prevent the chances of readmission of different blood borne viruses (Dawson et al., 2015). Researchers are of the opinion that in case of homosexual men, at community as well as in individual levels, proper access to the sustainable housing, income as well as connection with the gay community helps on playing essential roles in the facilitation of the services and caring for the group. Refugees as well as asylum seekers are often seen to face stigmatization and discrimination and they are found to mistrust professionals. Therefore, building of trust among the communities and maintaining their privacy and confidentiality is also important.

From the above discussion, it becomes clear that a hue number of vulnerable population in the nation is not accessing healthcare services for effective screening and prevention of the disorders of HIV. Some of the main reasons are their poor health literacy, stigmatization and discrimination and many others. Unless such populations become aware of their high risk of developing the disorder and the importance of screening and preventive programs, the epidemics of HIV in the communities will continue to haunt the nation. Therefore, community nurses should take proper evidence based strategies and thereby implement them in ways by which they can help the vulnerable individuals overcome the barriers the face and undertake proper screening and preventing programs and develop their health literacy effectively. This will help in developing a safer future for the individuals.

 

References:

Amaro, H., Raj, A., Vega, R. R., Mangione, T. W., & Perez, L. N. (2016). Racial/ethnic disparities in the HIV and substance abuse epidemics: Communities responding to the need. Public Health Reports.

Baral, S., Holland, C. E., Shannon, K., Logie, C., Semugoma, P., Sithole, B., ... & Beyrer, C. (2014). Enhancing benefits or increasing harms: community responses for HIV among men who have sex with men, transgender women, female sex workers, and people who inject drugs. JAIDS Journal of Acquired Immune Deficiency Syndromes, 66, S319-S328.

Batchelder, A. W., Gonzalez, J. S., Palma, A., Schoenbaum, E., & Lounsbury, D. W. (2015). A social ecological model of syndemic risk affecting women with and at-risk for HIV in impoverished urban communities. American journal of community psychology, 56(3-4), 229-240.

Boyer, C. B., Greenberg, L., Chutuape, K., Walker, B., Monte, D., Kirk, J., ... & Adolescent Medicine Trials Network. (2017). Exchange of sex for drugs or money in adolescents and young adults: an examination of sociodemographic factors, HIV-related risk, and community context. Journal of community health, 42(1), 90-100.

Dawson, A. J., Nkowane, A. M., & Whelan, A. (2015). Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review. Human resources for health, 13(1), 97.

Denno, D. M., Hoopes, A. J., & Chandra-Mouli, V. (2015). Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support. Journal of Adolescent Health, 56(1), S22-S41.

Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.

Kelly, A., & Symonds, A. (2017). The social construction of community nursing. Macmillan International Higher Education.

Kim, K., Choi, J. S., Choi, E., Nieman, C. L., Joo, J. H., Lin, F. R., ... & Han, H. R. (2016). Effects of community-based health worker interventions to improve chronic disease management and care among vulnerable populations: a systematic review. American journal of public health, 106(4), e3-e28.

Liamputtong, P. (2015). Stigma, Discrimination and Living with HIV/AIDS. Springer.

McCabe, B. E., Gonzalez-Guarda, R. M., Peragallo, N. P., & Mitrani, V. B. (2016). Mechanisms of partner violence reduction in a group HIV-risk intervention for Hispanic women. Journal of interpersonal violence, 31(13), 2316-2337.

Palacios, J. F., Salem, B., Hodge, F. S., Albarrán, C. R., Anaebere, A., & Hayes-Bautista, T. M. (2015). Storytelling: A qualitative tool to promote health among vulnerable populations. Journal of Transcultural Nursing, 26(4), 346-353.

Palacios, J. F., Salem, B., Hodge, F. S., Albarrán, C. R., Anaebere, A., & Hayes-Bautista, T. M. (2015). Storytelling: A qualitative tool to promote health among vulnerable populations. Journal of Transcultural Nursing, 26(4), 346-353.

Pearson, G. S., Hines-Martin, V. P., Evans, L. K., York, J. A., Kane, C. F., & Yearwood, E. L. (2015). Addressing gaps in mental health needs of diverse, at-risk, underserved, and disenfranchised populations: A call for nursing action. Archives of Psychiatric Nursing, 29(1), 14-18.

Poteat, T., Wirtz, A. L., Radix, A., Borquez, A., Silva-Santisteban, A., Deutsch, M. B., ... & Operario, D. (2015). HIV risk and preventive interventions in transgender women sex workers. The Lancet, 385(9964), 274-286.

Stanhope, M., & Lancaster, J. (2015). Public health nursing-e-book: Population-centered health care in the community. Elsevier Health Sciences.

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