Raine is 20 years of age and has been injecting heroin for five months. She has two young children and is pregnant. She lives in temporary accommodation but wants to move out fairly soon because of the poor conditions. She tries to avoid sharing injecting equipment and has shared once when she has been withdrawing from drugs and her supply of drugs ran out. She has been in contact with a drug agency for the last two months (She was infected with HIV by her partner and has been positive for one year and is not taking any drug treatment). She is four months pregnant and is worried about telling anybody and whether the baby will be infected with HIV as her other children are not HIV positive. You are required to choose ONE of the case studies available on Blackboard and in 3000 words demonstrate the achievement of the 4 learning outcomes by addressing the following points:
1. Briefly illustrate the scientific (nature of the disease, basic biology) social and historical factors that influence the Epidemiology (way of transmission, prevalence, mortality and morbidity) of communicable diseases and relate these to the specific case study.
2. Identify and critically discuss any areas of risk behaviour in the case study and link them to the literature.
3. Identify and critically discuss evidence-based interventions that may be needed and link the to theories of behaviour change.
4. Explain difficulties and obstacles, which may be encountered in implementing the proposed interventions and how these can be overcome.
5. Discuss any issues arising out of the case study from the communicable diseases, substance misuse and health behaviour perspective.
HIV or the human immunodeficiency virus is said to be a lentivirus which causes acquired immunodeficiency syndrome (AIDS) (Bell, Selby and McMickens, 2011). In this disease state the immune system of human body progressively fails and allows severe opportunistic infections, like cancers to increase (Thormar, 2013). Depending upon the virus subtypes average time of survival of the affected individuals without any treatment is approximately from 9-11years. HIV infection takes place by transmission of semen, vaginal fluid, blood, breast milk or pre-ejaculate. Within these fluids, HIV can be presented as both as free viral particles and as infected immune cells (Federal Ministry of Health, 2014). HIV infects the core human immune cells like T helper cells, dendritic cells and macrophages. Low levels of CD4+ Tcells are resulted from the HIV infection through different mechanisms, comprising uninfected bystander cells apoptosis, nonstop viral killing of contaminated cells and damage of contaminated CD4+ T cells by the CD8 cytotoxic lymphocytes which identify the infected cells (Albuquerque et al., 2007). If the numbers of the CD4+ T cell turn down below a significant level, cell mediated immunity will be lost and the human system will become progressively more prone to severe infections. HIV contains RNA or ribonucleic acid as their genetic material and requires a host ad reverse transcriptase enzyme to convert the genetic material RNA to deoxyribonucleic acid or DNA (Wagner, 2008). This virus can enter to the host cells and targets the system’s defense mechanism, offered by the immune system and the leucocytes. According to the WHO (World Health Organization) HIV is a retrovirus which contaminates the immune system cells and damage their functional properties (Watstein and Jovanovic, 2003). At the earlier stage of this infection, affected individual does not demonstrate any kind of indications or symptoms. However, later on during the progression of this disease the immune system of the affected individual becomes weaker and more prone to severe other infectious diseases, for example: pneumonia and tuberculosis (WHO., 2008). Like other blood borne viruses, HIV gets transmitted from one individual to another during un-protective sex along with sharing infected syringes and needles, transfusion of infected blood or blood products, mucus membrane, cerebrospinal fluid, semen, bruises or open cuts. During pregnancy a vertical transmission of this virus from mother to the baby is also possible. Substance misuse among the HIV affected bisexual and homosexual male increases the chance of getting affected with this disease. Nevertheless, researchers have demonstrated that injecting drug users are pretty aware of the requirement for proper conduct and sexual behavior.
Chimpanzees can bear Simian Immunodeï¬ciency Virus (SIV) in their system and that is harmless to them. These viruses are termed as retrovirus (Pepin, 2011). When this virus is transmitted to different primate, complications can arise. It is mentioned that earlier chimpanzees were hunted and eaten frequently by the tribal groups in central Africa. Thus by ingestion, the unique Simian virus was transmitted from chimpanzee to human (Tabor, 2007). The Simian virus got mutated inside the human body and thus the first HIV form was originated. The transfer of pathogen from animals to human beings, which fits well with the human immune deficiency virus, is scientifically termed as ‘Zoonosis’ (Lashley and Durham, 2007). For a successful transmission of these viruses require certain favorable conditions, for instance nearby host animal population, human population, infectious microorganism in host animal that is capable in spreading from animal to human being, good contacts among the species to transmit sufficient pathogens to humans which might have taken gigantic amount of individual contacts, ability of the microbes to spread among the human race probably by acquired mutation and various mechanisms that allow the viruses to widely disperse and prevention of infection from blazing out either by killing its human host or by provoking immunity among the local human populations. To illustrate the origin of this virus, researchers have found the possible time interval of the transfer of the cross-species (Hooper, 2000). The AIDS outbreak causes major risks to the economical, social and mental welfare of HIV infected individuals. This could adversely have an effect on household strength and sustainability, schooling, admission to health care and children’s susceptibility to infection. The WHO represented worldwide data on HIV (WHO, 2008). Almost 67% pregnant female are living with AIDS in middle and lower income countries and under the medicinal administration to protect their babies from the HIV transmission (Who.int, 2015). Globally almost 2million people have registered themselves to get antiretroviral treatment in the year 2013 (Who.int, 2015). 23%children are in the need for HIV treatment compare to 37%adults (Who.int, 2015). This also point out bigger gap existed between the services for children and adult living with human immunodeficiency virus. Therefore it is of utmost importance that the writer consider this issue as one of the major challenge in health care sector and will try to recognize the fundamental factors and develop these issues thoroughly by correlating them with Raine’s case study. This essay will demonstrate communicable diseases set up in this case study by dealing with their basic biology, historical and social factors, which influence their mode of transmission, morbidity, mortality and prevalence. This essay will also illustrate the areas of risk behaviors and correlate them to the research literature. Additionally, evidence based research will be involved to identify the issues affecting Raine and her family. Any probable complications and hindrance will also be discussed to implement the proposed interventions and the way these hurdles can be overcome. Finally, this essay will also demonstrate whether any issues are arising out of this case study from the communicable diseases, substance abuse and health behavior perception.
Areas of risk behavior in the case study
The 20years old female Raine has been injecting herion since last five months. She lives in temporary accommodation which is very poor in condition. She has shared injecting equipments. Therefore, it is clear to state that Raine has been abusing heroin that is considered as a class A controlled substance under the Drugs Act, 1971 (Legislation.gov.uk, 2015). Heroine dependence increases after several weeks and unexpected termination can gives rise to tremendously uncomfortable psychological and physical withdrawal indications for instance muscle pain, anxiety yet in the absence of bodily trauma. Sharing same injectable equipments also increases the possibility of HIV transmission from one individual to another. Heroin does not completely dissolve because it contains certain additives and during the injection can accumulate within the blood vessels which lead to the kidneys, brain and lungs (Dirks et al., 2012). This blockage can also leads to vein damage, collapse, local infection abscesses, thrombosis, heart valve infections, ulcers and circulatory complications. In this case study, Raine is pregnant and pregnancy exposes Raine to factors like weakened immunity, insufficient prenatal care and poor nutrition. Substance abuse during pregnancy is also associated with developmental delay, spontaneous abortion risk and low birth weight. Moreover, the unborn fetus may born with physical abnormality and dependency on heroin, can suffer from withdrawal syndrome and thus serious medical problems require hospital admission. To support this concept Oei et al. (2012) have published a review on amphetamines uses during pregnancy and its impact (Oei et al., 2012). The aim of their research was to evaluate and summarize already presented evidence about the amphitamines impact on pregnancy, the newborn and the child. Amphetamines are the neurotoxins and neurostimulants which are considered as the globally abused illicit drugs. The users are at the greater risk of mental co-morbidities and evidences have suggested that amphetamine exposure prior to pregnancy is correlated with reduced pregnancy outcomes and data is cofounded by other unpleasant factors linked with drug dependency (Oei et al., 2012). The researchers have used Government data conference abstracts, book chapters and published articles. The worldwide incidence of amphitaine exposure during pregnancy stage is probably underestimated but agreed to be rising rapidly, while contact to other substances is decreasing, like: heroin. Would be mothers using amphetamines are at the elevated risk of mental co-morbidity and inferior obstetric consequences but the newborns may escape exposure, as the withdrawal signs are commonly less defined than those infants who are exposed to opiates. Very little proof are present regarding amphetamine stimulated neurotoxicity and enduring neuro-developmental impact as information is limited and hard to remove from the control of other issues correlated with kids living in families where parents are into drug abuse in terms of neglect and poverty. Amphetamine exposure prior to and after pregnancy is a worldwide concern but in depth research, typically for the childhood consequences are still under the darkness (Lester and Lagasse, 2010). Hence the researchers have suggested that the kids may be at the risk of constant behavioral and developmental obstacle and suggest that attempts can be made to develop early recognition of exposure prior to the pregnancy and to develop provision of prior intervention services for affected individuals and their family members.
Another condition is that, Raine is pregnant and detected with HIV positive. As a result there is a high possibility of viral transmission to her fetus since she is not under the administration of antiretroviral therapy (Zarocostas, 2009). As Raine has shared injectable equipments it can be obviously mentioned that she may be a carrier of other type of blood borne viruses like HCV and HBV. Raine despite of her diagnosis with HIV is unwilling to undergo any medical assistance that can increase the risk of developing AIDS and subsequently death. Different researches have shown when individual stops applying heroin, acceptance falls rapidly and on re-initiating the system would not be able to manage with the same quantity and the individual can be at the risk of a drug overdose.
Evidence-based interventions and link with behavior change theories
Raine is four months pregnant and is worried about sharing this fact to the health care staff working with Raine. The drug workers have built a therapeutic association with Raine which is depending on trust (Lippke and Ziegelmann, 2008). As per scientist Barker therapeutic associations are the keystone of nursing practice with the individuals experiencing risk to their health. Good nursing intervention and assistance can modify Raine’s behavior to reduce HIV transmission to others. Though Raine is aware of the fact that prior a year she was affected with HIV but failed to obtain antenatal care and counseling about her pregnancy, possibly due to stigma associated with HIV diagnosis (Seckinelgin, 2007). Substance abuse is a powerful cause of stigma and is increased by HIV diagnosis. Mostly women who are diagnosed with HIV go through immense discrimination from the community and family members than males. So, it is obvious to mention that this stigma is the only reason why the affected women feel scared to share about their condition to other people (Rotheram-Borus, Swendeman and Flannery, 2009). They also feared that people may be blaming them. Raine and her partner can be benefited from HIV counseling. This can support them that in this world there are various people exist with this virus. IN terms of counseling, Raine and her partner need to be counseled together in order to give them an opportunity for informed choices relating to their lives. Counseling is always helpful as it gives knowledge, increase awareness, supports individual and explores individual’s thoughts and feelings that will stop further disease spread, allow treatment access, protection and care of the fetus (Liechty, 2004). Raine along with her partner can be benefited from Health Belief Model (HBM) (Carpenter, 2010). The health belief model and associated theory of rational action emphasize the significance of knowledge, positive attitude and beliefs regarding the advantages and threats of modifying individual behavior. As per this model, behavior is altered when an individual recognizes the requirement to alter their present behavior and approach towards specific action. Raine should identify if she is inclined to a particular difficulty, recognize the severity of the complication and provide consideration to altered behavior by analyzing prospect of its consequences (Gregson, 2006). Both Raine and her partner should acknowledge the complications which are considered unsafe as alterations are almost doubtful if Raine and her partner continue to understand their functions as satisfactory with no harsh outcomes to the involved lives. Sexually active females like Raine in this case should be faithful to her partner and take protective measures appropriately and unfailingly.
Health promotional education could be another important intervention regarding blood borne viral infections like Hepatitis A, B, C and airborne spread of tuberculosis could be useful for Raine and her family as they are at the higher probability to get affected with these diseases (Miilunpalo, 2000). Hepatitis A virus causes liver inflammation and can spread through extremely unhygienic food, environment, faucal and oral route and need to be treated immediately. HBV can cause liver damage as the human system responds to viral infections (Davis, 2010). The associated symptoms are headache, jaundice, raised temperature, fatigue and many more. HCV is a blood borne viral infection that affects the liver and causes liver disease and chronic infection. It is also probable that after infection inactive infection can persist and almost 10% of infected people can develop active tuberculosis in their life (Mohebati, Davis and Fry, 2010). Raine’s partner can be benefited from the cycle of changed model. This form needs an affected individual to experience following periods while altering behavior that are pre-consideration, contemplation, preparation, action, continuation and relapse (Fischler, 2002). In Raine’s case it is therefore, significant to mention that a multidisciplinary team should identify her cause of fear, offer additional support throughout counseling sessions to tolerate the complications faced.
Difficulties and obstacles in implementing the proposed interventions
Raine is pregnant; hence the most important part of concern is associated with her breast feeding. Avoiding breast feeding may make her anxious as it may represent a sign to the member living around her that is Raine is HIV affected. In terms of cultural reasons few women can find it hard to accept the fact of avoiding breast feeding apprehending the stigma, violence and abandonment as they are living with HIV virus (Macleod, 2010). It can be considered that Raine may be under the treatment of methadone and a psossibility is present injecting other medicines as poly drug user. Raine may get benefited from being instructed by drug workers on safe procedures of injection administration. Researchers have shown that almost 50% individuals who are under methadone treatment continued injecting cocaine regardless of the methadone dosage. Also, research study has established the fact that almost 80% individuals who are under the methadone treatment, considerably reduced the heroin use and almost 50% lessened cocaine usage (Evans and Lambert, 2008). The National Treatment Agency advocated that individual should exchange injecting sites in order to circumvent steady use of same injecting location thus reducing the threat of destructing the shin integrity (Ammann, 2002). In addition, research study also suggests that affected individual should be offered with the management for injection site infection with hepatitis testing, hepatitis vaccine with several follow up approaches.
Difficulties may have risen in terms of cultural belief. Raine’s partner may be unwilling to use protective sex measures, like use of condoms as he might belief that male has the only right to decide where, when and how sex will take place. These types of beliefs can make male uncomfortable regarding revealing that they are unaware of certain facts and thus limiting their information access. This condition can worsen the male and females’ susceptibility to sexually transmitted infections and HIV (Smyth, Barry and Keenan, 2001). The deficiency of financial stability of the women exposes them to male supremacy. In such conditions women depend on their male partners for financial support plus supply of addictive drugs and making sure a stable supply would be present in terms of sexual surrender (Schubert, 2005). This intervention would be to appoint Raine in meetings on the application of social cognitive theory. With the help of this theory Raine can learn behaviors by modeling other’s behavior or by straight experience among the self help groups. At the end of the session it could be expected that Raine will be empowered to demand safe sex with his partners along with protective measures, as this will stop HIV transmission between the couples.
Issues arising out of the case study
Other concerns arising out of this case study includes that Raine and her partner are at risk to other infections for example sexually transmitted disease and invasive pneumococcal disease. The affected individuals detected with HIV infection had different types of invasive pneumococcal disease infections in the last 10years (Williams, Gunter and Nicholas, 2006). If Raine and her partner are infected they can get benefit from invasive pneumococcal disease vaccines for affected individuals with HIV regardless of CD4 count. Additional data demonstrated that people who are recently diagnosed with invasive pneumococcal disease and with human immunodeficiency, majority were parallaly diagnosed with sexually transmitted infections (Kunnuji, 2013). Raine and her partner should be screened for sexually transmitted infections also and should be treated with appropriate medications if affected with any. Additionally if Raine and her partner are found to be positive for hepatitis C, they should be administered with suitable medications for hepatitis C and acquired immunodeficiency.
To conclude it should be mentioned that communicable diseases pose major impact of most of the peoples’ lives internationally (Strauss et al., 2002). Most of the people have learnt to alter their behavior for their own good because of the shocking effects of HIV and other blood borne viruses. Though awareness is high, still affected individuals are kept isolated, stigmatized and abused in different societies guiding to fear for accessing treatment and assistance. The state government and WHO policies have stated the fact that it is human right to access treatment when they require it rather than hiding it because of the fear of stigma. The reduction of harm because of HIV and other blood borne viruses are successful where measures are efficiently applied. Despite of the fact that HIV is untreated, with the introduction of various effective therapies affected individual can live a normal life.
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