Question

focusing on health disparities and interventions in a population outside of the United States. Choose any of the issues or diseases (or make your own up!) from the list below that are considered global public health problems.

TB

Malaria

HIV/AIDS

Access to water

Water quality

Air pollution

Ebola

Sanitation

Cholera

Climate change

Healthcare

In your introduction, briefly describe your issue or topic. Also, provide epidemiological information on the following: morbidity and mortality among the specific group, community, or country. Next section will be your methods, in which you describe keywords and how you conducted your literature review. Then, in your discussion section, discuss at least three interventions published in the scholarly literature to address the crisis in a country of your choice. Evaluate the progress and outcomes of such prevention programs. Describe the intervention (e.g. target audience, experimental/control group, intervention methods and materials, intervention outcomes) Assess the methods used in the intervention (e.g. level of the intervention, strengths and weaknesses of the intervention, potential impact/generalizability of the intervention). Conclusion offers a good wrap-up of everything discussed wherein!

E.g. Access to water in Kenya. Approximately 11% of the world’s population does not have access to safe or affordable drinking water; unfortunately, 46% of the population continues to have inadequate access to quality water in Kenya. Some interventions addressing this issue include: water kiosks, household water pumps, rock catchments, and boreholes. One program was implemented in Nairobi, Kenya …. It was successful because… Another program was implemented in Kitui, Kenya… It was unsuccessful because…

Submit a 3-5 page paper outlining the information below.

Include in your Assessment Paper: (40 points)

Abstract. (5 points)

Introduction to the topic of choice (one paragraph). (5 points)

Answer all questions pertaining to your topic in Discussion section. Your methods section is also included in these points. (10 points)

Conclusion- summary of overall research, quality, and potential recommendations you would (or would not) make regarding this global health issue.

Answer 1

HIV AND AIDS- PREVALENCE AND PREVENTION IN INDIA

INTRODUCTION

  

HIV infection in India was first detected in 1986 among female sex workers in Chennai.India is home to the second largest population of people living with HIV and AIDS. The Government of India estimates that about 2.40 million Indians are living with HIV (1.93 ‐3.04 million) with an adult prevalence of 0.31% .Children (<15 yrs) account for 3.5% of all infections, while 83% are the in age group 15-49 years. Of all HIV infections, 39% are among women.

The executive director of the Global Fund for AIDS, TB and Malaria, suggested that in 2004, India overtook South Africa in having the largest number of people living with HIV/AIDS in the world.The true prevalence of HIV in India is still debatable. Some of the available estimates of incidence have been carried out among sex workers in Maharashtra (22.1 per 100 person years) and drug users in Chennai (4.53%)

Although the epidemic was initially described among sex workers, the prevalence of HIV among sex workers has more or less stabilised because of targeted interventions, increased condom use, and empowerment strategies that encourage sex workers to demand safe sex from clients. Meanwhile, housewives with single partners are gradually accounting for a larger proportion of infections.These monogamous women are primarily put at risk by the extramarital sexual behaviour of their husband, from whom their infection is most probably acquired. The housewife is becoming the new face of the epidemic in India; a trend that necessitates research on microbicides and other female controlled HIV/STD prevention technologies.

Short Abstract:

Contributing factors to the epidemic, the burden of the disease are studied by collecting statistical reports from various sources, thay are analysed , the prevention programmes implemented are studied and suggestions made for the prevention and management of the disease.

METHODS:

A qualitative descriptive research study can be done for this topic.

The samples will be selected by random sampling technique.The researcher directly does not implement any interventions since it is a non experimental qualitative research.

Literature review:

Apoorva, J. et al (2013) conducted a study on 'Risky Behaviors among HIV-Positive Female Sex Workers in Northern Karnataka, India' AIDS Research and Treatment, where she explains the key affected population of India as Men having sex with men, injection drug users, sex workers and transgenders.The target interventions and antiretroviral treatment modalities are also studied in this research.

In 2016, an estimated 2.2% of female sex workers in India were living with HIV, although this figure varies between states. one 2013 study cited HIV prevalence among sex workers in Maharashtra at 17.9%, Manipur at 13.1%, Andhra Pradesh at 9.7% and Karnataka at 5.3%.

Anita Nath(2017) conducted a study on Pediatric HIV in India: Current scenario and the way forward in which she has emphasised on prevention of parent-to-child transmission and antiretroviral therapy services .

The reseacher has discussed that the prevention of parent-to-child transmission and antiretroviral therapy services for HIV-infected mothers and children have been rapidly scaled up over the recent years. Despite these advances, a large number of HIV-infected children are born in every year. The efforts of National AIDS Control Organization, UNAIDS, UNICEF, and World Health Organizationhat are made to control pediatric HIV are challenged by a large range of factors such as low health service utilization, poor drug adherence, delayed infant diagnosis, discriminatory attitude of health providers, loss to follow-up, and poor coordination in managing continuum of care. These challenges may be addressed by adopting innovative and effective strategies and strengthening the existing health system. This would bring about a significant reduction in pediatric HIV incidence and improve the outcomes in children who are HIV infected.

Keywords: Antiretroviral therapy, National AIDS Control Organization, pediatric HIV, prevention of parent-to-child transmission,prevalence,prevention.

DISCUSSION:

NACO (National Aids Control Organisation )is the body responsible for formulating policy and implementing programmes for the prevention and control of the HIV epidemic in India. The most recent programme, NACP-IV (2012-2017), aims to reduce annual new HIV infections by 50% through the provision of comprehensive HIV treatment, education, care and support for the general population and build on targeted interventions for key affected groups and those at high risk of HIV transmission.

Targeted interventions for key affected groups

A key component of the NACP-IV is the prevention of new HIV infections by reaching 80% of key affected groups with targeted interventions. This five-year project began in 2014 and targets female sex workers through 87 community based organisations across five southern states.

Project Sunrise

Responsible for the expansion of HIV interventions in north eastern states with a focus on key affected populations, particularly people who inject drugs. The project began in 2016 with the central goal of getting 90% of people who use drugs who are living with HIV from this area on treatment by 2020. It will also look to build the capacity of state-level institutions to respond to the needs of people who inject drugs and other key affected populations in order to prevent HIV and expand treatment. Other interventions include working with the spouses of people who inject drugs.

Project NIRANTAR

This three-year project began in 2014 and focuses on building the capacity of civil society organisations working with key affected populations in the states of Chhattisgarh, Madhya Pradesh and Odisha. Its main aim is to improve access to HIV prevention, care and treatment services, including social protection schemes, in an enabling environment.

Migrant Interventions at Source and Transit

This project targets both working migrants and domestic migrants who have returned home. Returnee migrants and their spouses are reached in villages and at places of transit such as bus or train stations. Working migrants are targeted through the industries that employ them, with more than 200 contracts signed with various industrial employers. The intervention is expected to reach more than 5.6 million migrants.

HIV education and awareness

Increasing awareness among the general population and key affected groups about HIV prevention is a central focus of India’s current National Control Programme (NACP IV), which is being implemented between 2012 and 2017. Behaviour change and generating demand for condoms and other prevention commodities are key focuses.50

Link Worker Scheme

The Link Worker Scheme works in 163 districts across 18 states to address the complex needs of rural HIV prevention, care and support. It involves highly motivated and trained community members, responsible for establishing links between the community on one hand and information, commodities and services on the other. In 2015, the scheme reached 1.06 million migrants and 972,000 people from other vulnerable groups.

The Condom Social Marketing Programme (CSMP)

The Condom Social Marketing Programme (CSMP) aims to promote safer sex. A key focus of the programme is making condoms readily available in rural and remote areas and in high-risk places such as truck stops. In 2015, the CSMP distributed more than 2.83 million condoms.52. In the same year it launched a new condom promotion campaign on Doordarshan (India’s public broadcasting service) leading cable and satellite channels, All India Radio and private radio in Hindi and other regional languages. The campaign aimed to encourage audiences to adopt safe sex practices by using a condom every time they had sex.

Antiretroviral treatment:

  Free antiretroviral treatment (ART) has been available in India since 2004. At ART clinics, people living with HIV can access HTC, nutritional advice and treatment for HIV and opportunistic infections. Patients are required to take a CD4 count test every six months.57 In 2016, 50% of adults eligible for ART received treatment, rising from 36% in 2013.58 Despite the rise, the number of people on ART remains low. Many people living with HIV have difficulty accessing the clinics, emphasising the importance of initiatives such as the Link Workers Scheme.

Over the past decade, India has made significant progress in tackling its HIV epidemic, especially in comparison with other countries in the region. For example, while new HIV infections in India have fallen by more than half since 2001, the number of new HIV cases in neighbouring Pakistan has increased eight-fold.

A major reason for the country's success has been the sustained commitment of the Indian government through its National AIDS Control Programme, which has been particularly effective at targeting high-risk groups such as men who have sex with men, sex workers and people who inject drugs.

While antiretroviral treatment is free, uptake remains low and requires a dramatic scaling up. especially in the wake of the new 2013 WHO treatment guidelines. Moreover, stigma and discrimination remains a significant barrier preventing key affected groups and those at high risk of HIV transmission from accessing vital healthcare services.

CONCLUSION:

In the past 20 years, the country has made substantial investment in HIV prevention. In the past five years there has been significant scale up of Voluntary councelling and testing services and capacity building for care and support. While retaining this focus to prevent backsliding of prevention, the next decade should be devoted to developing excellence in HIV care, reducing stigma thereby permitting increased uptake of services and making additional efforts to tackle the disparity in distribution and affordability of ARV agents.