Public Health Intervention

Intervention for internalised HIV stigma arises at an individual level being deeply rooted in theoretical assumption as per Goffman's work on shame (Campbell, Grifiths & Wilkins, 2016). Goffman terms as a process through which individuals are disqualified from social acceptance due to an undesirable label. This label can be e an attribute of physical behavioural or health outcome, which is highly discrediting. For those needing support in exploring such complex topics, healthcare dissertation help can provide valuable guidance.

Such names develop a perception that possessor labels are less desirable. Goffman reduces the processor from a whole and usual person to a tainted individual (Mumin et al. 2018). Hence it can be conclusively stated that stigma is rooted within the social interaction. The theory additionally highlights that stigmatisation demands more than mere labels; instead, a language of relationship is essential. Goffman stated that stigma is based on something more than just names consisting of two primary components; firstly recognition of differences based on the name and secondly, consistent evaluation of the possessor. Hence, it can be conclusively stated stigma was a direct manifestation of the behaviour and attributes (Bates & Stickley, 2018). The shame of gay individuals suffering from HIV is a process heavily linked to the maintenance of structural and social power inequalities

According to Goffman, an individual's personality is a dual entity one possesses both an actual and a virtual social identity. An individuals' virtual social status comprises characteristics and qualities one is assumed to have as per the expectations and norms decided by society. Actual social status is composed of characteristics and traits of an individual's feeling that he or she may possess (Jones, 2017). The homosexual individuals belonging from the stigmatised group must learn to reconcile the differences between the actual identity and their virtual identity, which in turn violates the social norms termed acceptable by society. The truth of the specific claim is severe importance if the nurses are seen to make a significant contribution in reducing the impact of stigma on the life of HIV positive gay patients. The professional being the nurse or doctor whose job includes working with and supporting people with HIV is clearly in a position of trust and power. However, there remains evidence making the chosen theory highly flawed (Tyler, 2018). Uses of HIV health services are highly stigmatised by the healthcare service providers and can recount distressing experiences of their treatment, patience carrying extra burden of stigma due to their partner preference. The attitude of nurses towards HIV among the patient is a life-ruining event accompanied by a loss of a deficit of individual’s ability to function is quoted as a significant manifestation of stigmatising behaviour (Krupchanka & Thornicroft, 2018). It is for the same reason that the nurses should understand how differences in virtual personality from their actual nature of the patient can help in understanding the logic behind stigma. The stigma arises from various factors such as:

• 39% of people feel those with same-sex partners more likely to suffer from HIV as compared to two couples from opposite genders (Campbell, Grifiths & Wilkins, 2016).
• 67% of people stated HIV is highly contagious and may spread if they are not careful with the infected person (Mumin et al. 2018).
• 19% stated that HIV is a weakness in personality, and 15% said people with HIV need to remain isolated away from the healthy population (Campbell, Grifiths & Wilkins, 2016).

Nurses fail to receive any specialised training in HIV prevention and care especially for incidence to reduce stigma (Mumin et al. 2018).Furthermore, registration training for the nurses does not include possible ways that can be implemented to reduce the incidence of stigma relating to sexual health services. Hence, in the absence of HIV training, there needs to be some ambiguity about the precise task or roles of the nurses required to prevent stigmatisation of HIV patients irrespective of their sexual preferences. The gay people are already termed weird by the society, making them prone to high level of stigmatisation. The responsibility of reducing stigma related to HIV depends on individual nurses. As stated by Bates & Stickley (2018), the nurses should educate themselves about HIV and homosexuality. The nurses should understand that homosexuality is not the cause of HIV and give people suffering from AIDS need not be stigmatised due to sexual preferences. The nurse should additionally be aware of their behaviour and attitude and pass on the positive facts challenging the existing stereotypes and myths. Stigma within healthcare facilities undermines treatment and diagnosis hindering positive health outcomes. It becomes imperative to state that answering the stigma is essential in developing quality healthcare achieving optimum health irrespective of gender and social status (Bates & Stickley, 2018). Nurses can make use of several key strategies for reducing stigma within the healthcare setting for the gay HIV patients. Firstly provision of information consisting of the condition of HIV for the associated stigma, its manifestation and effect on health outcomes. Skill-building activities involved creating a score for the nurses to develop suitable skills to work in close contact with gay people suffering from HIV who are often stigmatised approach to participatory learning demands the participants for the nurses to actively engage in the intervention (Bates & Stickley, 2018)

The nurses can additionally make use of the empowerment approach for improving the coping mechanism of the gay people suffering from HIV to overcome the stigma associated with them.

Similar to the Ebola virus, AIDS is transmitted through direct physical contact with infected body fluids. Nurses’ professional responsibility is to become knowledgeable about HIV transmission and prevention of stigma (Jones, 2017). If the nurses educate themselves, then they can inform the patient and public history of shame being repeated again that is often a disease when it reaches an epidemic proportion. Hence, it can be conclusively stated, and it is essential to understand the possible ways that can be implemented for reducing those chances of stigmatisation of gay individuals and their family members. The nurses need to embrace better proactive measures and open attitude in reducing the stigma

Teenage pregnancy is a matter of concern for young girls who often lack the required knowledge. The proportion of curing outside the marriage was roughly 90% compared to 36% of the women from all the ages (Larcher & Brierley, 2016). However, the frequency of birds occurring in girls under 16 years in England and Wales increased to 1500, highest since the early 80s (Hummel, Saxena & Klingler, 2018). However, as per the Nufflied intervention ladder the UK teenage pregnancy strategy underlined by the government's health department. Initially, the policy started with the step of providing information for educational purposes. The administration then went a stage for the enabling choice to help people change their behaviour (Sheppard, 2016). The teenage girls were taught to refrain from risky sexual behaviours that can make them pregnant, thereby raising adolescent pregnancy statistics. Furthermore, the government works on making use of financial incentives for influencing people not to pursue risky sexual behaviour. Adolescent girls are encouraged to learn and attend educational institutes. The government additionally puts restrictions over the use of illicit drugs that may give rise to risky sexual behaviour leading to unintentional pregnancies.

The young mum needs to be educated about the pros and cons of early pregnancy, not in regards to moral panic (Mezey et al. 2017). Money is definitely a disadvantage for people with early pregnancy, and the mother or the partners need to work hard and be employed for providing a suitable life to the baby. The advantage of the current policy is that it allows for a Framework for executing continuous decision making and action. Finally, the chosen strategy is highly effective, providing additional advantage by explaining the procedures and rules that apply to all the women or young girls experiencing teenage pregnancy irrespective of their cultural or social-economic status. There are additional potential disadvantages while developing the policy and implementing it (Hadley, Chandra-Mouli & Ingham, 2016).

As per Hadley, Chandra-Mouli & Ingham, (2016), a decade old teenage pregnancy strategy was launched by the UK Labour Government, with the prime aim to reduce the conception rate. The strategy was inclusive of strategy implemented of comprehensive program across 4 themes at national and local level for better prevention of improved relationship and sex education with effective access to contraception. The support program is intended to teach the young parents important of contribution to the strategy and help the young parents prevent unplanned pregnancy by breaking the chain of early pregnancy. Program was implemented through national, regional and local structure with dedicated funding for a period of a decade. The underwriting contraception rate significantly reduced within a decade old lifespan. Everyday pregnancies among teenagers influence the web of interconnected factors the strategy was highly multifaceted in its approach. Hence it is not easy to identify the possible causative pathway for estimate the expected relative contribution of each as constituent part. However one can conclude that the features contributed to the success suggest creating a scope for action developing evidence based practices making and effective implementation while regularly reviewing the process and implementing the strategy in wider government programs for providing leadership and right kind of guidance through the program. The learning remains relevant for the UK as England's teenage birth statistics is comparatively higher than the neighboring European countries. Strategic intervention provides vital lesson for the English government and the possible policymakers in the other countries who are seeking various ways to reduce the rates of teenage pregnancy in their country.

The amalgamation of cultural sanctioning and access to services demand for pregnant teenagers helps them to avoid unwanted pregnancies and opt for abortion. Without this, there remains a chance of increasing prevalence of teenage mothers and a culture disapproving abortion. This, in return, manifests a likelihood of an increase in future pregnancy among the teenagers and self-reinforcing cycle (Loganathan, 2017). The access to abortion is essential determinant influencing teenage pregnancy rates. Evidence suggests an increase in restriction in access to abortion do not result in higher adolescent birth rate and is linked with a reduction in adolescent maternity. Hence, it can be conclusively stated as per the Marmot's report existing health inequalities makes it increasingly difficult for the teenage population to avoid unwanted pregnancy. This period to diminish the existing quality in regards to teenage pregnancy is in keeping with a broader increase of existing health inequalities that are observed over the last ten years despite the country shading in a flight over public health for reducing health inequalities (Isaranuwatchai et al. 2019). In reference to the gradually falling rates of teenage pregnancy since the late 90s, it may be perceived as an outstanding prospect for the policymakers to consider events of adolescent pregnancy and issues which have mostly been resolved. However, by considering the possible psychological impact of teenage abortion couple with the goal of free help of tracking disparities, the government suggest that reducing chances of adolescent pregnancy, especially in the deprived authority's needs to remain a constant priority in regards to public health opinion (Ingham, 2016). Reports additional services state that cycle of rejecting abortion among the young teenage mothers in a deprived area is generally degrading over a period of time. Intervention may be termed as a positive and dynamic shift m towards the reduction of teenage pregnancy the implication of this over the provision of sexual health services and promotion of better sexual health for young people must be explored.

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The teenage pregnancies need to be reduced with a prime aim to educate the young generations about the hardships of the same. The teenagers need to be exposed to sources to make sure that they refrain from risky sexual behaviours. In addition to that, stringent policies and laws need to be developed to make sure that teenage pregnancies need to be stopped. Hence, it can be conclusively stated, a combination of stringent policies can work on providing the much-expected results.

Reference list

• Bates, L., & Stickley, T. (2018). Confronting Goffman: How Can Mental Health Nurses Effectively Challenge Stigma? A Critical View of the Literature. In European Psychiatric/Mental Health Nursing in the 21st Century (pp. 493-503). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-319-31772-4_35
• Campbell, T., Grifiths, J., & Wilkins, R. (2016). Young HIV-positive people and experiences of HIV stigma in the UK: a pilot study. HIV Nursing, 16(4), 123-127. https://www.researchgate.net/profile/Tomas_Campbell/publication/312198055_Young_HIV-positive_people_and_experiences_of_HIV_stigma_in_the_UK_A_pilot_study/links/587cf8ad08ae4445c06b521a/Young-HIV-positive-people-and-experiences-of-HIV-stigma-in-the-UK-A-pilot-study.pdf
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• Krupchanka, D., & Thornicroft, G. (2017). Discrimination and stigma. In The Stigma of Mental Illness-End of the Story? (pp. 123-139). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-319-27839-1_7
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