HIV Prevalence in West Midlands

Introduction

Whereas latest reports by Chau et al (2016) indicated that the number of HIV cases in West Midland plummeted in 2017 for the first time since 2001, the prevalence of HIV in the region is still worrying. Specifically, Ottewell & Rodger (2018) indicate that 327 people were diagnosed with HIV in 2017. This has triggered concern from the academics, the healthcare fraternity and the general public over factors that could contribute to such new diagnoses. Considering the current focus on technological advances in HIV treatment, Skingsley et al (2015) argue that there is a paucity of research evidence highlighting the risk factors for HIV infection and transmission within the current context. Hence, the main aim of this study is to explore the risk factors of HIV infection transmission and prevention among adolescents in the West Midlands.

Literature Review

Broadly, the HIV epidemic in the UK and specifically in West Midlands (WM) has been given a wide coverage by existing literature and academic articles which highlight the risk factors as well as the prevention measures for HIV. For instance, Barrett et al (2010) conducted a study to evaluate the risk environments of HIV in the case of Eritrean and Ethiopian immigrants in the West Midlands. Barrett et al (2010) are particularly important to the current study because apart from giving a comprehensive account of the historical background of HIV in the UK since 1999, the study provides rich literature regarding heterosexually acquired HIV, from an immigration perspective.

For instance, the study takes a qualitative approach to evaluate the risk environment of HIV and the people’s knowledge of HIV, its causes and preventive measures. According to McCormack et al (2016), knowledge of HIV is especially important in the fight against HIV because it is one of the contributors to the adoption of good sexual behaviour that reduces a population’s predisposition to HIV. Specifically, Barrett & Mulugeta (2010) found that whereas the immigrants were more aware of HIV while in their home country, this knowledge decreased once they arrived in the UK, and that they perceived the UK as a non-risky area for HIV. Moreover, participants in the study by Barrett & Mulugeta (2010) pointed out that in the UK, there was little information on the radio, TV and other media about HIV.

This finding is especially important in the proposed study as it may be used in gaining an idea about the current level of information and awareness about HIV as one of the measures taken to reduce HIV transmission (Elam et al, 2008). Hence, because the proposed study aims to identify the prevention measures of HIV among adolescent in West Midlands, the study by Barrett & Mulugeta (2010) is especially important in the generation of knowledge regarding how creating awareness of HIV among youths in West Midlands can contribute to the prevention of HIV transmission in the area.

Literature by Jordon et al 2000 will also be useful to the proposed study due to the comprehensive nature in which it covers HIV with a specific focus on West Midlands. Ideally, the main aim of Jordon et al’s study was to examine the antiretroviral therapy for HIV patients will little knowledge of prior treatment, through a systematic literature review. In doing so, the study collects and evaluates the evidence regarding the delivery of double, triple and monotherapy, and how each type of therapy compares with the others. Whereas the proposed study does not intend to dwell on the types of HIV treatments, literature by Jordon et al is especially important in evaluating issues to do with the cost of HIV treatment, and some of the most effective interventions for adolescents with HIV in West Midlands.

For instance, the study lists estimated monthly charges and costs involved in the maintenance of antiretroviral therapy, and the implications of these costs on the fight against HIV. Nonetheless, a major shortcoming of this study is that it does not give the latest data considering the fact that it was published in the year 2000. Literature from this study will, therefore, need to be interpreted within the current context for it to be practically applicable to the study.

The proposed study also intends to discuss the sexual minority (i.e. the gay and lesbian youths and bisexual) and how their sexual behaviour predisposes them to HIV acquisition and transmission. One study that will be useful in evaluating this group is the study by Kann et al (2011). The study is motivated by the need for population-based data on risky social behaviours and how this data can be used to develop effective public health interventions meant to address the needs of these special groups. Whereas this study does not focus specifically on West Midlands, its focus on sexual minority youth is especially generative in understanding some of the risky sexual behaviours of sexual minorities and how these behaviours contribute to HIV transmission. Moreover, Kann et al’s identification of various interventions to prevent the transmission of HIV among sexual minorities can be applied in the context of West Midland to assist in the prevention of HIV transmission.

Quantitative and qualitative research conducted in the last few decades have identified various behavioural factors among the adolescents associated with risk of acquisition of HIV in the UK. For instance, Macdonald et al (2008) acknowledge that such factors include non-protected sex, increased number of partners, as well as various psychological factors including depression. Nevertheless, Macdonald et al (2008) fail to comprehensively explore and report the psychosocial factors leading to the infection and transmission of HIV.

There are several changes that have occurred in the last few decades in regards to the social environment within which adolescents interact and how HIV is prevented. Consequently, new interventions such as the antiretroviral treatment and pre-exposure prophylaxis have emerged and are currently widely used (Desai et al, 2016). Moreover, other developments such as availability of self-testing kits have had a great effect in the youth and adolescent’s perception of risk of acquiring HIV and risk behaviours (Lampe et al, 2012). For instance, Gilbart et al (2015) argue that the knowledge that someone can have undetectable viral load whose dramatic effect is the reduction of risk of HIV transmission; can influence one’s sexual behaviour.

The context of sex among adolescents has also experienced a dramatic change especially with the availability of sexual networking through online platforms and web-based applications (Ostrow et al, 2002). As a result, according to Dolling et al (2016), a high level of sexual behaviour has been experienced among youth and adolescents. However, the specific roles of these factors in contributing to the spread of HIV are less clear.

Research Questions

i. What are the risk factors of HIV infection and transmission among adolescents in the West Midlands?

ii. What are the intervention measures that can be taken to minimize infection and transmission of HIV among the adolescents in the West Midlands?

iii. What are the challenges met by the health sector in preventing HIV infection and transmission among adolescent in West Midlands?

Study Objectives

i. To explore the risk factors of HIV infection and transmission among adolescents in West Midlands

ii. To identify the measures that can be taken to minimize infection and transmission of HIV among adolescents in West Midlands

iii. To identify challenges met by the health sector in preventing HIV infection and transmission among adolescent in West Midlands

Conceptual Framework

The main aim of the proposed study is to explore the factors that contribute to the infection and transmission of HIV among the adolescent youth in West Midland. Broadly, there is a paucity of knowledge on the social context of HIV infection and transmission among the adolescence, heterosexuality, and how the victims may react to the available interventions. National Institute for Health Research (2016) also argues that there is little knowledge regarding how these factors interrelate with other psychosocial factors to contribute to HIV risks among the adolescence. Similar remarks are made by Baral et al (2013) that whereas previous epidemiological enquiries have largely focused on risk factors at individual levels, there is a need to identify and evaluate data relating to multiple levels of HIV risk factors including structural and social levels.

Ideally, according to Bronfenbrenner (1979), the multiple levels of HIV risk factors and the complex association between these factors can easily be evaluated through a conceptual framework that incorporates socio-ecological factors and captures individual-level risk factors as part of a wider community environment. The proposed study intends to conduct interviews with adolescents of age 16 and above who were recently infected with HIV in order to study the various environmental and sociocultural contexts within which the respondents acquired HIV in the past two years. Therefore, the main aim will be to explore how these contexts influenced their acquisition of HIV and to use this information in informing various interventions meant to reduce the rate of HIV infections and transmissions among adolescents in West Midlands. The following figure illustrates the proposed conceptual framework:

The study intends to conduct qualitative interviews with adolescents age 16 to 19. Hence the study intends to adopt a qualitative descriptive research design based on the socio-ecological theory. According to Creswell (2017), qualitative research design enables the collection of empirical data to develop a hypothesis or theory using models and trends. The study will use qualitative in-depth interviews to identify the sociological factors that contribute to the infection and transmission of HIV among adolescents in West Midland and link these factors with other community and structural factors in order to come up with comprehensive answers to the research questions at hand. Interviews will be recorded using password-protected tape recorders and later transcribed in verbatim before being destroyed. Transcribed data will be subjected to a thematic analysis through coding. The analysis process will also consist of an analytic thematic framework to facilitate effective analysis using an inductive approach.

A second researcher will be nominated to verify the transcripts, construct thematic maps and compare themes to enable a high level of consistency throughout the analysis process. Any emerging discrepancies between the first researcher and the second researcher’s thematic framework will be resolved through discussions and redefinition of the themes. The redefined themes will then be compared with all the transcripts before ultimately summarising the data through thematic matrices (Elo & Kyngas, 2008). During the entire process, the socio-ecological framework will be used in organizing the themes and presenting the data.

Ethical Considerations

Gill et al (2008) argue that researchers who engage in qualitative studies must adhere to various ethical considerations especially because the study involves human participants. Against this background, the study will require all the potential participants to sign a consent form which informs them of the purpose of the study and other important details. There will be no collection of any personal information such as name, email address, location or residence so as to maintain their anonymity. The tape recorders used in recording the interviews will be locked under passwords and destroyed upon data transcription. Nonetheless, the researcher stands the risk of failing to gain access to the sample. To avoid this risk, the researcher will gain a negotiated access to participants from the administrative staff of the selected HIV care facility.

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