HIV Global Impact: UK vs. SA

Introduction

The Human Immunodeficiency Virus (HIV) is considered as one the global health challenge in which the most affected country is South Africa that has high prevalence of the disease within their population. In the UK, wide numbers of individuals are also found to suffer from HIV that has hindered the way of leading their life normally. Thus, in this assignment, the global health data regarding HIV in South Africa and the UK will be compared to understand to the extent each country is facing hindrance from the disease. The healthcare initiatives taken for tackling HIV in the UK and South Africa (SA) will be compared and critically discussed. Moreover, initiatives from the global health organisation in managing HIV and the extent of health inequalities present regarding HIV will be discussed. with an emphasis on the need for healthcare dissertation help to navigate the complexities of these issues effectively.

Background of HIV

Human Immunodeficiency Virus (HIV) is the virus which attacks the body cells that are responsible in fighting against infection leading the person face vulnerable condition to experience infection and diseases (Monaco et al. 2016). HIV is mainly spread through semen, infected blood or vaginal fluids. In most cases, it is seen that the HIV is transmitted from one person to another during sexual intercourse or blood transfusion or during sharing of same needles of HIV individuals in taking drugs (Dailey et al. 2017). The lack of treatment of HIV leads to Acquired Immununo-deficiency Syndrome (AIDS) which currently has no effective cure (Günthard et al. 2019). In 2000, the WHO reported that there are 34.3 million people over the world are living with HIV and they predicted in the year that by 2018 there will 37% increase in the number of HIV affected people (UNAIDS, 2000). However, with effective introduction of treatment all over the world the percentage rise regarding HIV predicted by WHO have declined. It is evident as by 2018, there were 37.9 million people were found to be affected by HIV which is 10.6% rise since 2000 (doctor-4-u.co.uk, 2018).

Background of HIV in the UK

The number of people affected by HIV in the UK is comparatively low which is evident as in 2018 there were 103,800 people with HIV in the UK among whom 4453 people are only newly diagnosed for the disease (nat.org.uk, 2019). It is also found that 93% of the HIV affected people in the UK are accessing treatment to control the disease and extensive awareness regarding the way to protect transmission of the disease is seen among the population (nat.org.uk, 2019). This indicates that 1 in 14 people in the UK not aware of being affected by HIV (nat.org.uk, 2019).

Background of HIV in South Africa

According to global reports, South Africa (SA) is one of the worst affected countries with highest number of HIV positive people. This is evident as of 2018 it is reported that 7.7 million people in SA are living with HIV. This indicates a prevalence of 20.4% HIV among the population. The HIV in SA is found mostly among gay men, transgender women, sex workers and individuals who are involved in taking drugs through infection (avert.org, 2019). There is lack of effective awareness and health education among the South African people regarding causes of HIV and way to prevent it which has led to worsened condition of the disease in the country. Moreover, SA has lack of adequate financial and medical resources to be spent in controlling HIV that led to higher prevalence and infection rate of the disease (Rane et al. 2018).

Comparison of Health Data regarding HIV in the UK and South Africa

The health statistics regarding HIV prevalence in 2018 within the UK mentions that nearly 103,800 people are affected by HIV and among them, 7,500 (8%) people are considered to remain undiagnosed for the disease (nat.org.uk, 2019). However, in South Africa, in 2018 it is seen that nearly 7.7 million people were affected by HIV and nearly 10% of the affected people remain undiagnosed for the condition (UNIAIDS, 2018). The comparison of the statistics revealed that there is high number of HIV cases present in South Africa compared to the UK. However, the diagnosis rate for HIV in both the countries that is the UK and the SA are quite high with only 10-8% of the population remaining undiagnosed. Thus, the lack of 100% diagnosis among the population in the UK and the SA may be further contributing to raise the overall prevalence of the disease.

In 2018, 0.2% of the HIV population is seen to be between 15-49 years in the UK (assets.publishing.service.gov.uk, 2018). However in South Africa, in 2018, it is reported that 19.7% of people who are between 15-49 years represent the total HIV population in the country (UNIAIDS, 2018). This indicates that less number of young individuals are affected by HIV in the UK compared to South Africa. In relation to sex, as reported in 2018, nearly 62.6% of the total HIV population in South Africa are women. Moreover, the HIV infections reports in South Africa mentioned that young women who are 15-24 years of age are more than double compared to men who are affected by HIV. This is evident as 69,000 new HIV positive cases for young women were reported in 2018 compared to 25,000 new HIV positive cases among young men (UNIAIDS, 2018).

In 2017, it is reported that 28,877 women of all age group were HIV positive compared to 64,472 men in the UK. The statistics also revealed that out of the total men found to be HIV positive in the UK, nearly 42,739 were gay or bisexual (assets.publishing.service.gov.uk, 2017). The statistics for HIV prevalence in respect to sex in the UK reveals that more men who are mainly gay or bisexual are the most affected whereas, in South Africa, the women are highly affected by HIV. In 2018, nearly 506 people are found to die from HIV in 2016 whereas 594 people died in 2017 within the UK which led to indicate that less than 1% of the people affected by HIV in the UK faced fatal consequences in the year (publichealthmatters.blog.gov.uk, 2017). However, in South Africa, it is reported that 71,000 people died as result of HIV in 2018 which is 25.07% of the total population (UNIAIDS, 2017). This indicates that the number of fatal consequences as a result of HIV in the UK is lower than South Africa which informs that HIV is more effectively managed and controlled in the UK compared to SA.

Global Health Initiatives and Policies for HIV

The increased spread of HIV in South Africa (SA) would create worst and deteriorated health scenario within the country and therefore effective implement of healthcare initiatives are required. The SA government have understood the vitality of the condition regarding HIV and therefore has taken few initiatives to overcome the situation. One of the initiatives was implication of Mobile Health Program for HIV Prevention and Management in South Africa. The program is developed with the three key aims that are increased counselling and testing of HIV/AIDS, making referral of HIV positive individuals to external health facilities and delivering health education regarding HIV among population (starforlife.org, 2018). As commented by Flick et al. (2019), early testing and counselling of HIV among individuals help to lower prevalence and fatal consequences of the disease. This is because the people who are HIV positive could be timely and effectively aware of their condition to avoid involving in sexual practices which often leads to increased spread of the disease. As criticised by Wall et al. (2019), hindered health education regarding HIV leads people to involve in unsafe sexual practices which leads to spread of the disease. This is because the individuals are unable to understand the importance of precaution suggested for protective sexual activities in controlling HIV. However, with the Mobile Health initiative, effective awareness among the people in South Africa could be created in making them avoid including in unsafe practices that lead to spread HIV, in turn, acting to lower prevalence of the disease.

In implementing the Mobile Health program, a professional nurse along with two HIV counsellors is involved who work in collaboration with the Start for Life Coaches and skilled teachers in schools. The healthcare staffs through the organisation of HIV prevention campaigns try to reach the people in the communities and young people at schools to make them aware of the activities to be avoided to prevent HIV (starforlife.org, 2018). As criticised by Braitstein et al. (2019), young people are prone to get affected by HIV. This is because they lack knowledge regarding safe sexual practices and the actions to be taken to avoid getting infected with HIV. Thus, the target of education young people regarding HIV in the initiative is effective as would help the novice to avoid involving in safe practices that leads to spread HIV. The South African government under the Female Condom Program has taken the initiative to distribute free condoms to the female. In 2016, it is mentioned that through the initiative nearly 26 million female have distributed free condoms in the country. However, the program is mentioned to be extended and by 2040 it is determined that more than 40 million female in the country are provided free condom through the program (Beksinska et al. 2017). This is an effective approach because use of condoms during sexual intercourse prevents the passage of HIV from one person to another. Moreover, it is also effective to prevent unwanted pregnancy among young females, in turn, acting to provide multiple benefits to the individuals apart from HIV protection (Johnson et al. 2018).

In the UK, similar initiatives to South Africa are taken to avoid increased prevalence of HIV and ensure is effective management. In this purpose, the HIV Prevention England program is formed which is the national HIV prevention and management program for England. This program is targeted for people who are already HIV positive. In the program, the affected people are educated regarding the strategies to be taken to avoid spread of the disease. Moreover, they are informed about the healthcare services available for them and the way to access them to get effective treatment for their health condition. The program also provides resources to health professionals to arrange campaigns regarding HIV prevention (HPE, 2018). As commented by Sajeev (2018), healthcare campaign regarding HIV helps to aware people regarding the key causes and risk factors for the disease. Therefore, effective assistance from the program by the health professionals in the UK would help them to spread increased healthcare education and awareness regarding the health to ensure towards it efficient coping.

The “It Starts with ME” is another campaign taken by the UK government with the objective to raise awareness and uptake of increased HIV testing, enhance motivation in using preventive measures for HIV and provide support and access to prevention and testing tools for HIV. In the campaign, the “Test-Treat-Protect” message is delivered to stress responsibility on each individual in acting to stop spread of HIV (startswithme.org.uk, 2018). This is an effective initiative as it leads the common individuals in the UK become aware and alert about the role to be performed by them to avoid increased prevalence of HIV, in turn, contributing to lower the incidence of the disease holistically. In the UK, through the campaign, the National HIV Testing Week on each November is executed so that more people with HIV are diagnosed to be provided timely care. In other times of the year, the campaign is focused on mentioning prevention methods such as use of condom during sexual intercourse and educates Treatment as Prevention for HIV to the population (startswithme.org.uk, 2018). This campaign is effective to control HIV in the UK as it focuses on each aspect of care such as medical care, testing, health awareness and others required in holistically preventing HIV.

Global Health Policies for HIV

In SA, according to the National HIV Counselling and Testing Policy Guidelines, the children above the age of 12 years are allowed to access HIV testing without requirement of prior consent from their parents (nicd.ac.za, 2015). It indicates that there are provisions for minors in the SA to avail HIV testing without knowledge of their parents. This is effective as it provides freedom to the minors to test for HIV and access treatment who out of fear of revealing to their parents regarding their condition with HIV avoid getting care for the disease and develop worsened health condition. However, in the UK, no such policy provisions are available where the minor can avail HIV without the consent of the parents. Thus, it limits the freedom of the minor in availing testing for HIV in the UK. In the UK, through the “Treat all” policy that is implemented under WHO and UNAIDS recommendation, immediate and compulsory care for individuals are provided after the diagnosis of the disease (avert.org, 2019). This is effective to provide timely treatment to all individual with HIV in the UK as it allows availing medical support in managing the disease. However, in South Africa, there is no stated policy which ensures immediate HIV treatment to be provided to the patients as soon as HIV diagnosis. This has led to delayed care and control of HIV in the country which in turn has contributed to wide prevalence of the disease out of hindered control (Church et al. 2015).

In the UK as well as in South Africa, there is presence of anonymous HIV test policy available for the people. According to this policy, the people assumed to be affected by HIV or not can access testing for the disease in any sexual health clinic without revealing their identity (nhsgrampian.org, 2019). As argued by Rasoolinajad et al. (2018), HIV positive patients are often discriminated in society out of negative beliefs and perception regarding the disease. This leads many individuals with HIV to avoid testing and availing care out of revelation of their identity and facing discrimination in society. Thus, the anonymous testing policy for HIV in both countries is an effective step in making more people access diagnosis of the diseases without fear of facing discrimination out of revelation of their identity. As asserted by Zhang (2018), antiretroviral (ARV) drugs are effective in preventing HIV among people. This is because the medication avoids the virus causing HIV to stop replicating, in turn, reducing the overall viral load in the body that also lower damage in body functioning. In the UK and South Africa, ARV drugs are found to be provided free of cost to all individuals under their health policy (clicks.co.za, 2015). This is effective to enhance medical management of HIV among all individuals in both countries.

Partnership approaches in South Africa and the UK for managing HIV

In South Africa (SA), the Unitaid and National Department of Health of South Africa have formed partnership in accelerating the effort of the country in treatment of HIV. The joint endeavour is planned to introduce self-screening of HIV along with expanding HIV preventive measures to adolescent women, girls and children under 5 years of age in the country. It is also formed to support enhanced first-line HIV treatment in the country (Unitaid, 2019). This is because in SA there are wide instances of unsafe sexual intercourse been seen among all individuals of different age. Thus, promoting prevention measure to be educated would put a bar on the unsafe sexual practice among all and self-screening would lead to improve timely diagnosis of HIV to delayed treatment regarding the disease that is responsible in wider prevalence of the disease along with deteriorated health condition of individuals.

The poverty line is referred to income level and financial ability in meeting minimum living conditions. A person living below the poverty line indicates the individual has lack of finances in supporting their most basic needs such as education, health food and others in everyday life (Rodriguez et al. 2018). The LCS in 2015 reported that 40% of the South Africans are living below poverty line indicates there is increased presence of poor people in the country who lack effective financial resources to meet their everyday needs (statssa.gov.za, 2019). In this condition, the self-screening support provision for HIV by the Unitaid with the South African government is an effective approach in promoting diagnosis of the disease. This is because self-screening for HIV is cost-effective and it allows diagnosis for HIV to be reached to remote population who do not have effective access to healthcare. It creates wider support in detecting presence of HIV among population to determine where HIV services are required to resolve the increased spread of the disease (Viviano et al. 2017). In the UK, there are 20% people as of 2017 found to be living below the poverty line which indicates that most of the people have effective financial condition in meeting their needs (fullfact.org, 2019). However, irrespective of the financial ability of people, in the UK, partnership are formed with by the National Healthcare Services (NHS) with the King’s Fund in delivering integrated free care and education regarding HIV to the population (nat.org.uk, 2019).

In South Africa, there is low education regarding causes and spread of HIV among population. Thus, it has led to raise increased negative beliefs and stigma regarding HIV and its treatment among the population (Probst et al. 2016). As argued by Haffejee et al. (2016), HIV patients are marginalised from society and healthcare services. This is because people believe that HIV people are deserved to be punished as it is their fault to develop the disease and they are able to transmit it others through contact. Moreover, HIV patents are discriminated from the society out of beliefs of people that the individuals are involved in disapproved relationship (gay, sex workers, etc). It hindered reach of HIV care to the affected individuals, in turn, creating deteriorated impact on their health out of HIV (Evans et al. 2016). Thus, the CDC South Africa has developed partnership with Arum Institute and Winnie Mandela Male Sexual Health Clinic and others to ensure reach of HIV care services without discrimination to the infected people in controlling spread of the disease and enhancing well-being of the population as well as the affected individuals (CDC, 2019). Moreover, CDC South Africa has developed partnership with the Centre for Aids Programme Research to treat co-infected patients with HIV without discrimination (CDC, 2019).

In South Africa as well as in the UK, it is seen that the government agencies have partnered with the private and public educational institutions in educating regarding sexual health and HIV to the children at school and colleges (Pantelic et al. 2017; iea.org.uk, 2019). This is because it would spread detailed information with evidence regarding cause of HIV among the young people and children who are most vulnerable to get HIV out of hindered health education regarding the disease. In South Africa, sexual education and awareness are still considered as taboo among the population. This has led many individuals in the population remain unaware of the cause and health effect of HIV and other sexually-transmitted diseases (nai.uu.se, 2017). Thus, the partnership for spreading education regarding HIV and sexual health is effective in SA as well as in the UK to resolve the taboo and promote better health among the people.

Role of future nurses in managing HIV

The role of the nurses in South Africa and the UK as well as globally is to teach health behaviour to people for living without HIV and avoid its spread. This is because nurses are mainly involved in caring of individuals and are directly connected with the patients which provide them with the provision to use their knowledge in educating people to assist the individuals follow measures and precautions in preventing and controlling spread of HIV (Frain, 2017). As mentioned by Reyes-Estrada et al. (2018), nurses in HIV care have the role to counsel individuals and provide them health information to be followed in tackling HIV. This is because nurses through direct communication with patients are able to understand the leading cause of HIV spread in them which in turn makes them provide advice to individuals regarding the way behaviour change is to be made to tackle the disease. As argued by Medina-Marino et al. (2020), in HIV care, the nurses have the role to supervise patients regarding medication to be taken and monitor their health. This leads them to effectively promote public health regarding HIV as the individuals by taking appropriate medication for the disease as suggested by the nurses are able to act in avoid spreading the disease as well as avoid deterioration of their health due to HIV. Moreover, continuous monitoring of the health of HIV patients by the nurses assist them to determine the impact of their care on the individuals and accordingly make changes to ensure smooth care is provided to enhanced health of patients and HIV prevalence is lowered in the community (He et al. 2016).

The principles of HBM include perceived susceptibility, benefits, severity, barriers, cues to action and modifying variables (Mo et al. 2019). The nurses to play their role in health promotion for HIV among the people globally are to follow the principles in the Health Belief Model (HBM). This is because the HBM informs the ways in which interest of the population towards accepting any behaviour change required for disease management is to be created by health professional and nurses (Jeihooni et al. 2018). Moreover, people do not intend to change any behaviour or accept care with effectiveness until they believe there is risk towards their health regarding certain disease (Kocoglu‐Tanyer et al. 2020). Thus, by following the HBM as health model, the nurses would be able to make the people sense risk of HIV and need of the precautionary measures suggested in turn helping to create wider education and management of limiting prevalence of HIV in the society.

Conclusion

The above discussion mentions that HIV is a leading health issue in the global condition and South Africa (SA) is one of the worst affected countries whereas in the UK the prevalence of HIV is effectively controlled. This is evident as the death rates, prevalence rate and others related to HIV in South Africa is worst compared to the UK. In this respect, there are Mobile Health Provision and free distribution of condoms are made in SA to control sexual transmission of the disease. However, in the UK, it is seen that the NHS and Department of Health have formed various health promotion activities such as "It Starts with Me" and others in controlled HIV. In SA, there is health policy that supports free medication intervention for all regarding HIV management. However, in the UK, there is provision for free drug as well as non-drug care in HIV management for the general population. In SA, the partnership between CDC South Africa and Arum Institute, Winnie Mandela Male Sexual Health Clinic and others are formed in delivering care and education regarding HIV. Moreover, in the UK as well as in SA, the partnership is formed by the government with educational institutions, WHO and others in promoting health education and management of HIV.

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