Since it was first identified approximately three decades ago, the incidence of Acquired Immune Deficiency Syndrome (AIDS) has exploded into a global pandemic. While it is believed to have originated on the continent of Africa, the prevalence of modern travel and transportation allowed the Human Immunodeficiency Virus (HIV) –the virus which causes AIDS- to quickly spread around the world. Treatments for AIDS and efforts to prevent or minimize the spread of HIV/AIDS has made it possible for those who contract the virus to live longer, healthier lives; that said, the disease still has no known cure. First-world nations such as the United States, The United Kingdom (England, Scotland, and Wales) have developed sophisticated health-care systems that offer levels of treatment for sufferers of AIDS that are out of reach for many millions in the developing world. This paper will provide an overview of HIV/AIDS in England and The U.K., including discussions about affected populations, approaches to treatment and prevention, the cost of care and treatment, and the manner in which treatment is provided. Additionally, consideration will be given to the British health care system and how it compares to that of the United Sates.
The country of England –alternately known as Great Britain, as well as part of the United Kingdom, is one of the most historically-significant nations in the Western Hemisphere and, arguably, the entire world. It was first settled by nomadic Germanic tribes over one thousand years ago; in the subsequent centuries England’s influence grew exponentially, reaching many parts of the world. By the second half of the second millennium A.D., the scope of England’s reach was so vast that it spawned the expression “the sun never sets on the British Empire” (national geographic, 2013). The English language is spoken throughout many parts of the world, and has become the common language of international politics, finance, and commerce. England’s political, social, and cultural influence has been enormous, with nations around the world having adopted its parliamentary structure; many such nations were formerly part of the British Empire, and moved towards such governmental systems as the Empire largely dissipated in the 19th and 20th centuries. Although England is no longer the political, military, and commercial center of the Western world, it remains an influential and powerful nation. Like nations around the world, England has been significantly affected by the HIV/AIDS crisis; unlike some nations, however, England has both the medical resources available to first-world countries and a nationalized health care system that ostensibly provides access to HIV/AIDS prevention and treatment programs for all its citizens.
Introduction to England
England proper does not comprise the entire island of Great Britain, though it does cover the largest portion of it. England shares the island with Scotland and Wales; the nation of Ireland lies to the west of Great Britain. Geographically, much of England is covered with rolling hills, a feature which historically suited practices such as domesticating livestock and various forms of agriculture. Contemporarily, England has developed into a prosperous and modern nation, and is one of the key members of the European Union. Despite the entry of Great Britain into the EU, England and the rest of the United Kingdom chose to forgo adopting the euro as their currency, and they continue to use the pound sterling as their national currency. In the aftermath of World War II, the British economy began to shift from a heavily-industrialized, manufacturing-based system to one that is more service-oriented. England is heavily involved in the global pharmaceutical industry, and is also a significant participant in the banking and financial sectors. England has a large educational sector; 93% of British children attempt public schools (national geographic, 2013). England has only one private university; of the many dozens of other colleges and universities, all are public.
The population of England is primarily white; 86% of the British people are of direct British ancestry. Of the remaining 14%, most are of Scottish or Irish descent. Other ethnic groups (such as black, Indian, and Pakistani) are represented in the single digits percentage-wise. Several major religions are found in England, the majority of which are various sects of Christianity, such as the Anglican, Presbyterian, and Roman Catholic. Other religions found in much smaller percentages include Islam and Hindu; the remaining 23% profess no religious affiliation (cia.gov, 2013). The official language is English, though there are several regional languages spoken in the United Kingdom as a whole, including Scots, Scottish Gaelic, Welsh, Irish, and Cornish (indexmundi.com, 2013).
England has approximately 53 million inhabitants, has the largest population in the U.K., and one of the largest in the EU (cia.gov, 2013). Like many member nations of the EU and participants in the global economy, England was hit hard by the economic downturn of 2008, and has since continued to face challenging economic circumstances. The standard of living, as measured by “actual individual consumption -how much a person consumes in all goods and services, including benefits and welfare from government” (thisismoney.co.uk, 2012), has fallen in England both relative to its own economic history as well as relative to the standards of living in other EU nations. It is just outside of the top five out of the 27 member nations of the EU; above it are Austria, Germany, Switzerland, Norway, and Luxembourg. England has a high literacy rate at 99%, and a low infant mortality rate at 12 deaths per 100,000 live births. The current life expectancy for the total population is 80.29 years (cia.gov).
The National Health Service (NHS) is responsible for providing medical and health care to the people of England; the countries of Scotland, Northern Ireland and Wales each operate their own individual NHS organizations. The NHS is publicly funded, and the majority of its services are provided at no cost to residents. The NHS does charge for some services, including some prescriptions, eyewear, and dental services. General physician visits, emergency treatment, treatment for illnesses, end-of-life treatment and other such services are all provided with no fee for service. While the NHS has been on the receiving end of complaints and criticism, it has ranked well against similar programs in other nations, and boasts of England’s falling infant mortality rate and rising life expectancy as evidence of its success (nhs.uk, 2013).
HIV and AIDS in the U.K.
As a singular entity, The NHS in England is well-positioned to maintain an overarching and comprehensive approach to dealing with HIV/AIDS. As the organization responsible for meeting nearly all of its residents’ medical and health-care-related needs, the NHS can gather statistical information, conduct research, coordinate treatment and care and provide educational and public-awareness information for those who have or are at risk for HIV/AIDS. Although the NHS in England is governed independently of that in Scotland, Wales, and Northern Ireland, the individual NHS bodies in each nation coordinate their services as the NHS of the U.K.; therefore much of the official statistical information provided by NHS is compiled for the U.K as a whole, rather than for individual countries. As England is by far the largest country within the U.K., with over 80% of the total population (cia.gov, 2013), the statistics for the U.K. overall should be viewed with England’s proportional size in mind.
The incidence and prevalence of HIV/AIDS in the U.K., while still consequential, is proof of the effectiveness both of prevention efforts and advances in treatment for those who have acquired HIV or have developed full-blown AIDS. Because treatments have become so effective, people who have acquired HIV are living longer, healthier lives, and with proper treatment many are able to postpone or eliminate the onset of AIDS (NAT, 2013). It must be remembered, however, that despite the advances made in the field of HIV/AIDS treatment, there is no cure; prevention of HIV infection and appropriate treatment, while more effective than ever, have not eliminated the problems of HIV/AIDS.
HIV/AIDS Statistics for England and the UK
By the end of 2011, approximately 96,000 people in the UK were infected with HIV; this figure represents a significant increase from the prior year, when the number was approximately 91,500 (hpa.org, 2013). In terms of prevalence in the overall population, the 2011 figures equate to 1.5 infected individuals per 1000 people. Among the most at-risk groups –i.e.- the demographic sectors of the population that exhibit the highest rates of infection with HIV- are members of the black African community and men who have sex with men (MSM). In the former group the prevalence of HIV infection is 47 out of every 1000 people; in the latter group, the prevalence is 37 out of every 1000 people (hpa.org, 2013).
According to the NHS, there are a significant number of people who are infected with HIV yet are unaware that they carry the virus. In both 2010 and 2011, the NHS reports, 25% of those who are living with HIV do so without realizing their condition (nhs choices, 2013) This is a particularly troubling figure, for a number of reasons; among these are the fact that those who are unaware they have been infected with HIV are potentially at greater risk of infecting others than are those who are aware of their condition and take measures to avoid spreading the virus. On an individual level, persons infected with HIV who are unaware of their condition will therefore be delaying treatment; as research has shown early treatment for HIV is the most effective means to avoid the development of full-blown AIDS (nhs choices, 2013), it is clear that those in high-risk groups should seek testing on a regular basis.
Although the recent statistics show an increase in the number of people living with HIV in the UK, a look back over the last eight years actually shows an overall slight downturn in the number of newly-diagnosed infections. The highest rate of newly-diagnosed HIV infections in the UK was in 2005; this rate has dropped by 21% between 2005 and 2011, to a figure of 6280 (hpa.org). At the same time as the number of new diagnoses has been dropping overall, there has been a notable increase in new diagnoses among the MSM population. According to the NHS, this jump may be attributed to changing perspectives and beliefs about HIV/AIDS in the minds of the public, as new, more effective treatments for AIDS lead many to believe that the condition is no longer as serious as it once was (nhs choices, 2013). While there is no question that treatments for HIV/AIDs have improved significantly in recent years, HIV infection and AIDS are still quite serious and potentially deadly for any who acquire them.
Perhaps not surprisingly, the highest rates of prevalence and new infections of HIV in England are seen in London; other cities and metropolitan areas throughout the UK also demonstrate higher per-capita rates of prevalence and new infections than are seen in suburban and rural areas (hpa.org, 2013). In 2011 over 70,000 people in the UK were being treated for HIV/AIDS; the majority of those in treatment demonstrated viral loads low enough to avoid full-blown AIDS (NAT, 2013). The vast majority of those being treated for HIV were receiving antiretroviral therapy (ART), with fully 87% of those receiving treatment were virally suppressed and therefore considered to not be contagious (hpa.org, 2013). Those who received a late diagnosis –i.e.- several years after initial infection and often displaying symptoms- were ten times more likely to die within a year of their initial diagnosis than were those whose diagnoses came earlier (hpa.org, 2013).
Cost of Treatment for HIV/AIDs in England and the UK
Recent reports provided by the NHS and other AIDS-related organizations make it clear that the advent of more effective and life-prolonging treatments have also led to rising costs for treatment. The organization known as “NAM” (which originally stood for “National AIDS Manual” in the 1980s, and now operates simply as NAM) examined statistics and figures from the last several years to reach some stark conclusions about the costs associated with HIV/AIDs treatment. By their accounting, the annual cost of treatment in the UK will reach £758 million by the end of 2013; in U.S. currency, this figure exceeds $1.2 billion (Carter, 2011).
As the overall costs of treatment for HIV/AIDs continue to rise, it must be noted that ART and other early-intervention treatments are likely saving money as compared to the medical and social costs that would be generated if such early treatments were less effective. By providing early diagnoses and interventions for those infected with HIV, health care providers are helping people to live longer, healthier lives, and are in many cases turning HIV/AIDs into a manageable, chronic condition (NAT, 2013). As the public awareness of the importance of early diagnosis and treatment grows, it is likely that the number of people receiving treatment for HIV infection will grow as well; concomitantly, however, the number of people developing (and dying from) full-blown AIDS has been declining.
The cost of treatment for HIV/AIDS on an individual basis varied from one person to another, depending on the timing of the diagnosis, the individual viral load, and other factors. For those receiving early treatment, the cost of ART drugs and other adjunctive medications can be considerable, but are generally still low as compared to the cost of treatment for individuals whose conditions are more advanced. Those in later stages of infection or who have developed full-blown AIDS may still be treated with ART drugs; at the same time, they may have associated conditions (such as pneumonia or other opportunistic infectious diseases that take hold in the weakened immune system) that require additional and expensive treatments. The 2011 estimate of the individual annual cost of treatment for HIV/AIDs was £18,000; in U.S. dollars, this figure is approximately $29,000 (AVERT, 2013).
When comparing the costs of treatment for HIV/AIDs in the UK and in the U.S., it must be recognized that the health care systems in the two nations are structured in markedly different ways. While the U.S. federal government provides health care for some U.S. residents through programs such as Medicare and Medicaid, the vast majority of Americans access health care through private insurance or do not have health care coverage of any kind (AVERT, 2013). For those who are uninsured, some federal programs such as the Ryan White Care Act provide funds for HIV/AIDs treatments to the AIDS Drug Assistance Program (ADAP).
The 2010 estimated annual cost of treatment for HIV in the U.S. was $23,000 (Carter, 2011) . While this figure is not far off the mark from the figure seen in the UK, it bears repeating that the system in the U.S. makes it more difficult for some patients to receive care; those without medical insurance or other means of paying for treatment and health care may simply forego treatment, while those with adequate insurance may seek treatment earlier, thereby receiving ART medications and other treatments that help patients maintain allow viral loads and avoid developing full-blown AIDS. According to the Centers for Disease Control (CDC), approximately 50% of U.S. residents who are diagnosed with HIV have no access to regular health care; of those who do have access to health care, nearly half are recipients of Medicaid services (Carter, 2011).
By comparing the ways in which England and the U.S. deal with the HIV/AIDS crisis, it is easy to see the start differences in the two systems. While overall per-person costs are similar, virtually all residents of the UK receive free treatment for HIV, while nearly half of U.S. residents have no access to HIV treatment or other health care services. The statistics in the UK also clearly demonstrate that early diagnosis of HIV offers a dramatically lower risk of developing full-blown AIDS; those who receive early diagnosis and effective treatment are now living with chronic-but-manageable conditions, a marked improvement over the days when diagnosis with HIV was tantamount to a death sentence. With continued advances in treatment and public-awareness campaigns about prevention and early diagnosis, the AIDS epidemic may eventually be reduced to a significant, but manageable, health care concern on a global scale.
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