Chronicle Disease HIV, Research Paper Example

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Research Paper

Description and challenges

Human immunodeficiency virus (HIV) infection and gained immunodeficiency syndrome (AIDS) have developed as one of our most significant public health issues. Current assessments are that 38 million people are living with HIV worldwide.  In 2003 annual mortality was measured at 2.9 million with over 20 million deaths having happened since the first cases of AIDs were distinguished in 1981. Also in 2003, an estimated 4.8 million people became newly infected with HIV. In accordance to the centers for disease control and prevention (CDC), in 2003 an estimated 1039000 to 1185000 persons in the USA were living with HIV/AIDS. The CDC measurements that around 40,000 persons become infected with HIV each year.

The very first documented case of HIV-1 infection came from a stored serum sample gathered in 1959 from an adult Bantu male in Democratic Republic of Congo. Furthermore, HIV-2 ancestors have dated back to the 1940. Put the timing of HIV-1 came to human from the chimpanzee, while HIV-2 has sources from the sooty mangabey, which harbor SIVcpz and SIVsm respectively. In SIVsm’s natural host, which contains chimpanzees, sooty mangabeys and African green monkeys, SIVsm does not impact on disease high viral load. It is not until it is available in an “unnatural” host that disease development is linked with chronic immune activation, T cell lacking and subsequent immunodeficiency. This interesting difference has created the basic for studies to calculate the mechanisms of immunopathogenesis in HIV infection.

The HIV virus can be identified as early as two weeks after infection and HIV antibodies can be discovered within four to six weeks. In a group of 12 men who have sex with men in whom seroconversion to HIV infection was documented. 11 subjects evolved an severe infectious mononucleosis like illness. The illness was of sudden start, survived from 3 to 14 days and was connected with fevers, sweats, malaise, lethargy, anorexia, nausea, malign, artralgia, headaches, sore throat, diarrhea, generalized lmphadenopathy, a macular erythematous rash and thrombocytopenia.

The duration of the incubation period can be influenced by factors such as age and co morbid condition. Since the emergence of the epidemic in the early 1980s the numbers of HIV infected persons has gradually increased. In comparison, the mortality from HIV connected diseases has diminished. All deaths among persons with HIV and not due to HIV disease. “They can be secondary to causes not related to HIV infection, such as myocardial infarction or motor vehicle accident. With improved treatment, survival after a diagnosis of AIDS has become longer, allowing a greater proportion of deaths of persons with AIDS to result from other causes” (Veniegas, et. al, 2009.).

People living with HIV/AIDS face distinctive psychological and social issues.  HIV does not just destroy the body. It also impacts on a person’s psychological and emotional well being. HIV and opportunistic diseases of the brain and nervous system can modify people’s brain and nervous system, resulting psychological disorders. Regardless treatment for HIV, the burden of pain perseveres and people with HIV go on with psychological and spiritual needs. Emotional and spiritual requirements consist of those coming from environmental, physical, and social tensions and grief and bereavement; culturally adequate treatment of existing or new mood and anxiety conditions; treatment of other mental challenges, including drug abuse and addiction; and the need to ` issues related to meaning of life, control, and self-esteem. Several studies have recorded the complications faced by people living with HIV infections as they attempt to handle common signs or symptoms, including peripheral neuropathy, fatigue, depression, and anxiety.

Social sequelae can include having to deal with fears of communication, sickness, and death, and additionally with stigma and discrimination, and the need to develop coping techniques. Harding and colleagues report that despite treatment, there is the recognition that the pressure of pain continues and people with HIV continue to have psychological and spiritual needs, though community burden in delivering home care and psychological needs are under discovered describes how prayer is often used as a symptom management strategy for people living with HIV in an ethnically diverse sample.

Due to the frequency of fears and misconceptions, there is a stigma connected to people who are HIV positive. To exclude this stigma companies could try to get HIV-Positive people to inform fellow workers. In this way they can assist to remove the stigma attached to HIV and Aids. Stigma is strengthened by fear, denial and misconceptions. The stigma is so severe that people are uncomfortable to talk about the subject of HIV for fear of stigmatization or even stigmatizing others. HIV positive employees have to deal with this stigma. If their status is made known, there is a great possibility that their colleagues will discriminate against them. People tend to treat those living with HIV as ‘others’. If there is no proper education and awareness amongst employees, they will avoid working directly with HIV positive colleagues.

Employees who are HIV positive are required the following from management:

Assistance with direct access to health services outside the workplace if these are not accessible in the workplace, Time off from work to visit clinics or counseling, Transfer to lighter or less stressful responsibilities, where it is both required and possible. When employees are no longer able to work, they should be provided early retirement with normal medical benefits. Employees who retire due to ill health needs to be informed in advance of the benefits for which they may or may not be eligible.

“The most of the expenses of HIV/AIDS care has been approved by private health insurance and public programs. Persons with AIDS are more likely than the general population to be without insurance or to have Medicaid insurance. Medicaid is the particular payer for HIV/AIDS health care, with an expanding number becoming Medicare eligible; in 1990, more than 40% of AIDS care was covered by Medicaid, whereas Medicare pays for a small portion of AIDS care due to the 29-month waiting period from the date of onset of disability” (Makadon et al., 1990; Wilensky, 1991). Commercial health insurance plans paid $622 million in claims in 1993 and a total of $1.5 billion in AIDS-related life and health insurance claims (Health Insurance Association of America, 1994).

Little is known about insurance coverage of people with HIV who are not yet in regular HIV care. Existing testing of the CDC’s HIV security system database offers the first assessment of payer status at time of initial HIV identification, before entrance into HIV care. Insurance coverage diversified by race/ethnicity, sex, and visibility category at time of diagnosis.

For example, while similar proportions of men and women were uninsured, women were more than twice as likely to be covered by Medicaid at time of diagnosis. African American and Latino women were more likely to be covered by Medicaid than white women. Latinos were least likely to be insured. In addition, insurance coverage and timing of initial HIV diagnosis appear to be related. For example, between 34% and 54% were diagnosed late, depending on coverage. Those with private insurance were more likely to receive a late diagnosis (54%) than not (46%), while those with Medicaid, other public insurance, and the uninsured were more likely to receive an HIV diagnosis more than 12 months before their AIDS diagnosis.

There are techniques that help people to improve their control of conditions impacting HIV. Such health promotion features working on a range of levels including: interpersonal, group, organizational and societal, addressing any HIV issue, from primary protection to treatment and social policy. Health promotion activities for people living with HIV (PLWH) should address the discourse facts of living with treatments, aim to sustain emotional wellbeing, attain necessary skills in self care. The deficiency of appropriate, HIV relevant legislation affects the ability of persons living with HIV to live positively and persons sensitive or vulnerable to the disease from being able to protect themselves from the disease.

There are three critical challenges involved with young persons who are living with HIV:  the organization and maintenance of healthy life styles and adhesion to presented medical sessions, stopping the spread of HIV by youths who are affected, and escalating HIV + youths’ main focus on their standard of life and future plans. These objectives parallel an identical set of priorities that face society. Helping young HIV + women accommodate their serostatus is a high priority for public health professional in order to decrease long term costs for medical care, to decrease the number of new problems that could happen from transmission of the virus, and to maintain and/or increase the woman’s social contribution.

Community-based services progressed out of need to help individuals and a community in crisis (Chambre, 1995; Kayal, 1993). “Most outpatient care was offered by friends, family, and newly provided nonprofit organizations. These companies relied heavily on volunteer labor and were approved by individual donations. Paid and unpaid staff was mobilized to care for members of their communities” (Chambre, 1991a, 1991b).

Best practices within the chronic care model

To fully assist the management of chronic illnesses, a chronic care model has been grown and described more fully. In this model chronic care happens within three spheres: the community, the healthcare system, and the provider organization. The workings of each area can help or interfere with optimal care. In the community sphere, community sourced resources such as community support, social service resources, and policies provide critical linkages to provider companies.

In the health care system and provider spheres, the structure, objectives, and values of the provider organization and its relationship with purchases, insurance providers, and other providers are developed. These spheres support important dimensions of chronic care, including “recognition of the patient and family as the resource of control with the practice team participating and serving expertise and tools, the building of a care delivery structure that is adequate to the planned management of patients with chronic illness with clear jobs for all staff, the incorporation of proof based guidelines into daily practice, and the development of clinical information systems that enable clinicians to plan care for both individuals and whole communities of patients and to track and receive suitable feedback. The management of HIV is very identical to that of other chronic diseases. It needs coordination of care, clinical incorporation of services, and development of delivery system and community relationships” (Koenig, et. al, 2010).

Drawing from the review of the chronic care literature and the quality chasm report specific, the committee acknowledges that HIV care system like the American health care delivery system as a whole is in need of fundamental renovation, not just small correction. When applied to HIV care, that idea reveals that allocating new funds to the current system will not likely achieve better outcomes; what is required is fundamental change in the structure of the delivery system and a remodeled financing system. Toward that end, the committee is convinced that HIV patients need to be cared for in a system that is particularly designed around the core concepts of the chronic care model and of the quality chasm report. That system does not exist today.

In the next passage, the committee focuses on the characteristics of a delivery system that would better incorporate these two conceptual areas for HIV care. If affected patients know their level, enter care, and stay in constant care over their lifetime, a previously fatal disease is transformed into a lifetime chronic disease, approving those impacted to preserve productive contributions to society. Appropriate medical management of the disease needs coordinated and incorporated expert care. Such medical care can be more effectively offered through arranged and accountable systems of care such as centers of excellence. Early infection status determination rather than AIDS determination guides to early therapy and prevention of both epidemic spread and development to serious disability for those infected. Changes in the understanding of the disease and enhancements in therapeutic technology also need appreciable changes in delivery system structure such as moving the main locus of care from social methods and providers supported by medical providers to medical care systems, settings, and providers supported by social systems and providers.

Challenges and strategies

“It is in this framework that the preceding deficiencies of dealing with HIV must be considered. First, the use of highly active antiretroviral therapy needs a unique perspective to treatment regarding when to start therapy, which combination of drugs is suitable for an individual patient, when to switch drugs if the primary combination is not efficient and so forth. This involves access to providers experienced in treating HIV” (Beaudin, et. al., 1996).Secondly, highly active antiretroviral therapy is too expensive. HIV is a family disease. It impacts on not just those diagnosed with HIV, but all family members whose lives are irrevocably modified becaue of HIV. Unfortunately, the social service delivery system and public resource of HIV care does not support this idea. Ryan White CARE Act funds can only be utilized for the benefit of the person with HIV disease. The only time that CARE Act funding can be used for an impacted family member is to support the affected member in becoming a better caregiver to the family member with HIV.

Furthermore the Housing Opportunities for people with AIDS Program, financed under the Department of Housing and Urban Development, offers housing solutions only to families that consist of a person living with HIV disease. In defense of the CARE Act and HOPWA, the laws that composed these programs was emergency legislation to approve to authorize federal resource to help states and local communities in meeting the crisis created by the HIV plague. Neither program was developed to support people with HIV disease or their families permanently.  What HIV has done, however, is expose the deficiency of our social service many families are when a devastating illness invades their homes. Because it is not likely that there will be major health and social service reforms that will address these requirements in the very near future, it is essential that solutions to maximize limited resources are sought. This may consist of seeking private funds to support display programs and forging associations across funding sources.

References

Beaudin, C. L., & Chambre, S. M. (1996). HIV/AIDS as a chronic disease: Emergence from the

plague model. The American Behavioral Scientist, 39(6), 684-684. http://search.proquest.com/docview/214752491?accountid=35812

Chambre, S. M. (1991a). The volunteer response to the AIDS epidemic: Implications for

research on voluntarism. The Nonprofit and Voluntary Sector Quarterly, 20, 267-288.

Chambre, S. M. (1991b). Volunteers as witnesses: Perspectives on AIDS volunteers in New

York City, 1981-1988. Social Service Review, 65, 531-547

Koenig, S., Pace, S., Leandre, F., & Pape, J. W. (2010). Successes and challenges of HIV

treatment programs in haiti: Aftermath of the earthquake. HIV Therapy, 4(2), 145-160. doi:10.2217/hiv.10.6

Veniegas, R. C., PhD., Kao, U. H., M.P.H., Rosales, R., & Arellanes, M. (2009). HIV prevention

technology transfer: Challenges and strategies in the real world. American Journal of Public Health, 99, S124-30. http://search.proquest.com/docview/215090528?accountid=35812

Makadon, H. J., Seage, G. R., Thorpe, K. E. & Fineberg, H. V. (1990). Paying the medical cost

of the HIV epidemic: A review of policy options. Journal of Acquired Immune Deficiency Syndromes, 3, 123-133

Wilensky, G. (1991). Financing care for patients with AIDS. Journal of the American Medical

Association, 266, 3404.

Health Insurance Association of America. (1994). Source book of health insurance data 1994.

Washington, DC: Author.

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