Response to Question One
Various factors have led to the current decline in diagnosis, linkage to care, retention of care, initiation of ART, and adherence among infected persons. These fields are part of the broad HIV/AIDs care continuum. Every year, the United States undertakes a campaign aimed at encouraging citizens to go for HIV/AIDs testing. However, there has been a significant drop of around 30% in the number citizens tested. There are several reasons that might have led to this decline. For example, many people are unaware of the possible risks of HIV infection that they might be exposed to. In other words, many people argue that HIV is only prevalent among gays and persons who inject drugs as opposed to heterosexuals and non-drug users (Gardner, McLees, Steiner, Del Rio & Burman, 2011). They also argue that the risk of getting infected is low because a large percentage of the population is not infected. Another factor that increases the risk of infection is long periods of separation from a sexual partner and engaging in high-risk behaviors within a brief period such as during vacations.
The major barrier for linkage and retention of care is lack of education on the importance of continued treatment. In addition, delayed treatment of HIV/AIDS after diagnosis is yet another factor that affects many people (Gardner et al., 2011). This is usually a problem caused by both the providers and the patients. Additionally, many providers are unable to re-engage persons who have been left out from care programs. Moreover, providers have not been keen to seek collaboration between themselves in the provision of healthcare services. As a result, the quality of the healthcare services offered have been negatively affected (Gardner et al., 2011). Furthermore, other key stakeholders such as community HIV prevention providers have not been fully engaged in the spectrum of care continuum.
With regard to initiation and adherence to ART, the major hindrances are social, psychosocial, and behavioral barriers. Psychosocial barriers include depression and low literacy levels. Other barriers are due to increased consumption of alcohol and substance abuse. The other factor leading to decline in adherence is age, which affects old people and adolescents. Finally, many people do not use a medication organizer, which can improve administration of medication in line with a specified schedule (Gardner et al., 2011).
Response to Question Two
People who abuse drugs through injections are at a higher risk of contracting HIV/AIDs compared to individuals involved in heterosexual relations. This is because they engage in the practice multiple times in a day and the needles are not sterilized before being passed from one person to another. There are two major social determinants of HIV/AIDs among people who inject themselves with drugs. First, socioeconomic conditions contribute largely to HIV/AIDs infections through injections (Dutta, Wirtz, Baral, Beyrer & Cleghorn, 2012). Due to frustrations and segregation with regard to economic matters, young people tend to engage in high-risk behaviors such as drug abuse. Since most of drug addicts cannot afford the drugs on their own, they form groups in which they share needles during injection. The sharing of needles accelerates the rate of infections to a large extent in the United States especially among people of African-American descent (Dutta et al., 2012). In addition, the rate of infections through injections is high among Hispanics. Notably, these are some of the poorest groups of people in the United States. Therefore, economic conditions of concentrated poverty have a hand in increasing the rate of HIV infections through injections.
Also, low levels of literacy are to blame for the surge in infections through drugs injections. Many Hispanics and African Americans have low literacy compared to their white counterparts. As a result, their knowledge concerning the health risks of sharing a needle is limited. For women among these populations, transmission is mainly through sexual intercourse with infected men rather than drug injection (Dutta et al., 2012). Drug abuse accelerates the rate of infection through intercourse because addicted persons tend to trade drugs for sex.
Response to Question Three
HIV incidence refers to the number of new infections in a certain population. On the other hand, HIV prevalence refers to the number of people living with HIV/AIDs at a given period. In the United States, the prevalence rates are higher among key populations compared to the total population. This means that key persons are most vulnerable to contract the disease if necessary measures are not put in place in advance. HIV incidence is high among gay persons and People Who Inject Drugs (PWID). Also, the prevalence rates are also high among these populations (Hall, Song, Rhodes, Prejean, Lee & Janssen, 2008).
There are different levels of HIV incidence in different parts of the world. For instance, HIV incidence among key persons in China is 50%, Australia is 67%, Thailand is 41%, and Peru is 60% (Hall et al., 2008). In the United States, HIV incidence among the key population is 70%. In Nigeria, HIV incidence is 37% while it is 68% in Iran. On the other hand, HIV prevalence among key populations is higher compared to the total population. For instance, among sex workers, the prevalence rate is approximately 23%, which is much higher compared to the entire population which has prevalence rate of 1% (Hall et al., 2008). The population of gay men is 1.2% of the total population. However, the HIV prevalence rate among this section of the population is 16%. The prevalence rate among transgender people is 23% while that of that of persons who inject themselves with drugs is pegged at 19%.
People Who Inject Drugs (PWID) represents a section of the population whose prevalence rates vary from community to community. In Azerbaijan, the prevalence rate is 10% while it is 16% in Tajikistan (Hall et al., 2008). In Ukraine, Cambodia, and Indonesia, the prevalence among these populations is 22%, 24%, and 36% respectively (Hall et al., 2008). For sex workers, the prevalence rates are higher in Europe and Asia compared with other parts of the world.
Dutta, A., Wirtz, A. L., Baral, S., Beyrer, C., & Cleghorn, F. R. (2012). Key harm reduction
interventions and their impact on the reduction of risky behavior and HIV incidence among people who inject drugs in low-income and middle-income countries. Current Opinion in HIV and AIDS, 7(4), 362-368. (For response to question 2)
Gardner, E. M., McLees, M. P., Steiner, J. F., del Rio, C., & Burman, W. J. (2011). The
spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical infectious diseases, 52(6), 793-800.(For response to question one)
Hall, H. I., Song, R., Rhodes, P., Prejean, J., An, Q., Lee, L. M., & Janssen, R. S. (2008).
Estimation of HIV incidence in the United States.Jama, 300(5), 520-529.(For response to question three)