Background of HIV/AIDS
Human immunodeficiency virus (HIV) pandemic remains a prevalent public health crisis both globally and in the United States. The world statistics estimate for HIV was 37 Million people by 2016 with 1.8 Million new cases reported in 2017. HIV is disproportionately high in Sub-Saharan Africa accounting for 66% of new infections worldwide. The CDC reports that of the 36.9 Million patients, 21.7 Million people are under antiretroviral therapy (ART). CDC estimates 1.1 million people were living with HIV in the US by end of 2016 with 14% of the population unaware that they were living with HIV. The Center for Disease Control and Prevention (CDC) estimates that over 700,000 have succumbed to HIV/AIDS since the recognition of the virus in 1981. US HIV statistics are varied across gender, gender identity, race, and region. While the pandemic is highly prevalent among the young aged 25-34, the HIV statistics are proportionately higher in bisexual and gay men accounting for 66% of all HIV diagnoses in 2017. The African Americans and the Hispanic community have the highest prevalence of HIV accounting for 43% and 26% of HIV diagnoses respectively. HIV is prevalent in the urban areas with the South recording the highest absolute numbers of HIV cases (52% of new HIV diagnoses in 2017), the Northeast reporting the highest rates of HIV and the Midwest reporting the least cases of HIV(CDC, 2019). While the US National HIV/AIDS Strategy 2020 seeks to reduce the burden of HIV and AIDs, the chronic diseases remain a constraint to public health.

HIV is a virus that progressively destroys infection-disease fighting CD4 cells subsequently weakening the body immune system. Untreated HIV infection advances to Acquired Immune Deficiency Syndrome (AIDS). There exist two genetically distinct viruses; HIV-1 and HIV-2, with HIV-1 being the prevalent type with over 60 known strains. The virus is spread through contact with contaminated semen, rectal fluids, pre-seminal fluids, vaginal fluids, blood or breast milk. HIV is transmitted through unprotected vaginal or oral sex, sharing of non-sterilized injection equipment or mother to bather infection through pregnancy, birth or breastfeeding, blood transfusion, and organ transplant. The transmission occurs only if mucous membrane or damaged tissue is in contact with contaminated fluids or if the fluids are injected directly to the bloodstream. There exist myths and misinformation on other possible transmission mechanisms such as handshake, hugs kisses, sharing of dishes, doorknobs and toilet seats with people with the virus, pets, and insects. Such misconception manifest into existing social stigmatization of HIV and marginalization of HIV victims. The CDC (2019) reports that roughly 1 in 8 HIV patients do not access health care services due to discrimination and HIV stigma.

Landmark scientific and biomedical research advances have resulted in the development of prevention strategies, treatment options and improved care for HIV patients (Fauci, et al., 2019). A combination of biomedical; behavioral and structural interventions provides a holistic approach in HIV management. The advances in HIV treatment has considerably narrowed the life expectancy gap between people living with HIV virus and accessing quality treatment and HIV-uninfected individuals (Marcus et al., 2017). Fundamentally, HIV prevention strategies such as abstinence, use of condoms, limited sexual partners and HIV prevention medicines such as post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) are the advisable approaches of preventing HIV infection. Currently, there exist no commercially available curable treatments or vaccines for HIV, hence the antiviral treatment is administered to suppress the viral loads.

Antiviral treatments are administered for managing HIV associated morbidity and prevention of further transmission. Introduced in the late 20th century, Antiretroviral therapy (ART) which is a combination of medicine accounts as the primary treatment option for prolonging viral suppression and restoring the immune system. While ART doesn’t cure HIV, it prevents the multiplication of HIV virus reducing the viral load to undetectable viral load which reduces the risk of transmission. The Department of Health and Human Services (DHHS) outlines that ART should be introduced CD4 count below 350/µL. However, DHHS recommends immediate introduction of ART for pregnant, or hepatitis B virus (HBV) or HIV-associated nephropathy patients irrespective of the CD4 count. ART is administered in combination of three HIV medicines derived from two varied drug classes out of the seven possible classes; protease inhibitors (PIs); nucleoside reverse transcriptase inhibitors (NRTIs); CCR5 antagonists, post-attachment inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTIs); integrase strand transfer inhibitors (INSTIs); and fusion inhibitors (Cihlar & Fordyce, 2016). Nurses are the primary caregivers so they play a forefront role in HIV treatment improvement and HIV prevention. The role or nurses transcends beyond the bedside care to integrating innovation behavioral approaches that increase rapid HIV testing and ART adherence. Spaulding et al. (2016) identify that higher rates of HIV screening initiated by nurses as opposed to physician demonstrating the nurse's fundamental role in HIV management. Nurses provide both critical medical and psychological care necessary in diminishing the existing HIV stigmatization.

Population Improvement...…facilities using rapid-test kits improves the convenience of HIV testing. Public health campaigns targeting high-risk individuals is one of the interventions that can be used to attract them to rapid testing. The FDA approves two types of medication to prevent HIV infection: PEP (post-exposure prophylaxis) and pre-exposure prophylaxis (PrEP) Administration of daily PrEP among the uninfected high-risk individuals is an HIV prevention intervention. CDC (2019) reports that proper use of PrEP reduces the risk of HIV infection by 92%. PEP, on the other hand, is administered within 72 hours after potential HIV exposure to reduce the probability of infection. Addressing patient-provider communication appropriateness on the use of PEP and PrEP impacts on treatment effectiveness.

Cognitive behavioral change interventions focus on couples, families, peer groups, individual or institutions such as media, prisons, universities or religious centers. Intervention efforts that educate the significance of sterile syringe, syringe sharing, use of condoms and testing for STI among high risk gay and bisexual men, for example, reduces the risk of HIV infection exposure. Peer outreach strategies that address the social identity differences ensure a differentiated approach that is unique to the different groups. CDC statistics indicate that HIV incidence continues to increase among teenagers and adolescents Americans despite the stabilization of HIV rates among other groups. The statistics identify 56% of new HIV diagnoses in 2017 were among youths under 35 and were mainly sexually transmitted implying the need for community-level cognitive behavior programs that are youth sensitive. Organizing HIV training session during prenatal visits is one of the intervention approaches that nurses can integrate to ensure proper treatment and prevention of HIV transmission among pregnant women. As well partner services offered at community centers can significantly reduce transmission of HIV to the uninfected partner. Counseling services that seek to cultivate responsible for the behavior of the HIV infected reduce the probability of transmission of the virus.

Conclusion

It’s no doubt that HIV is no longer a new threat to public health as advancement in ART medicines has enabled an increase in life expectancy of HIV infected persons compared to the HIV uninfected population. A multidimensional approach is fundamental in managing HIV. The fundamental multidimensional initiatives ought to seek realizing early diagnosis, adherence in treatment and protection of infection among high-risk individuals. Addressing the fundamental challenges that result in disproportionate HIV prevalence in the US is the cornerstone of successful intervention efforts seeking to address HIV prevalence.

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