Prof_Marcos A.

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Running head: WOMEN WITH HIV

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Running head: WOMEN WITH HIV

Women with HIV

NR602

February 2019

Women with HIV

Human Immunodeficiency Virus (HIV) is an infection that affects all populations, irrespective of gender, ethnicity, race and social status. The virus was first discovered in the year 1981 and since then, many trials and researches have been conducted to find its cure. It has been noted that HIV has disproportionately affected women as well as adolescent girls. This is attributed the unequal social, cultural, and economic status of the female gender in society. In the United States, for every four people infected with HIV, one is a woman. All women regardless of age, ethnicity, and race can get infected with HIV; however, some women have a higher risk compared to others (Karbinski, Rosenberg, & Paz-Bailey, 2015). This paper identifies women infected with HIV as one of the marginalized groups in the society. It gives an overview and extensively describes the available demographic and epidemiologic data (incidence and prevalence), the economic aspects, social justice, and how it relates to the healthcare and health disparities of the group, associated ethical issues, and a realistic plan on how to address the marginalized group.

Background

The prevalence of HIV has been recorded as the highest specifically among the groups or members of the society who are most marginalized. It is evident that HIV disproportionately affects the individuals who have the least access or those that lack healthcare services and those who face the most discrimination (Paudel & Baral, 2015). The marginalized groups that have higher risk of acquiring HIV infection include, users of injection as well as the non-injection drugs, the mentally ill, sexual minorities, prisoners, racial minorities, illegal immigrants, refugees, the poor, commercial sex workers, homeless, and also those who lack insurance (Bertrand, Chan, Howe, Comella, Marak, & Bandy, 2016). The women who live with HIV have also suffered significant discrimination and vulnerabilities, hence form part of the marginalized groups.

Women have a higher risk of being infected with HIV because of various reasons. Some include intimate partner violence, unsafe traditional practices, and inequitable laws that reinforce or otherwise propagate unequal power dynamics between the males and females in the society. Women are more prone to the risk of rape and molestation, causing more vulnerability to being infected. Young women are the most disadvantaged. It is true that gender inequality mainly contributes to the high numbers of women with HIV and more so entrenches gender inequality (Paudel & Baral, 2015).

In 2017, there was approximately 36.9 million people worldwide living with HIV. More than 1.1 million people in the U.S. are living with HIV and 1 out of 7 people are unaware of having the disease, (HIV.gov, 2017). According to AIDSVu (2019), in 2015 there are approximately 106,585 people living with HIV in Florida, with 28.4% being female. In 2016, there were 4,940 new diagnoses of HIV. There are approximately 19,465 people living with HIV in Fort Lauderdale, Florida, with 26.4% being female. There were 762 new diagnoses in 2016, with 22.5% being female (AIDSVu, 2019).

Economic Aspects

Both at the local and international level, HIV plays a huge role in economic inequity for it affects the marginalized groups at a rate that is disproportionately high. Research shows that an individual’s socioeconomic status determines the likelihood of getting infected. It is also a key determiner of a person’s quality of life once they are diagnosed with HIV. For some women living with HIV, their situation has had a negative impact on their progress and development economically in various ways, such as consequences of stigma and discrimination, getting ill for long durations, access to health services, and the disease getting more severe. Increased levels of stigma are associated with decreased social support, being viewed negatively and weak, and decreased physical and mental outcomes. Many women also lose their jobs leading to a decrease in income and degrade of dignity (Kontomanolis, Michalopoulos, Gkasdaris, & Fasoulakis, 2017).

Social Justice

Marginalization of women with HIV has led to them being isolated and consequently losing their power within society as a result of discrimination. Women have an increased likelihood of being marginalized, unlike men due to their gender. The HIV risk or status can also make a woman get marginalized and she may experience more intense stigma if she belongs to a group in relation to her sexual orientation or race. To prevent stigma and discrimination of women with HIV, women need to be protected and receive equal treatment in society.

People with HIV are less likely to have access to healthcare and are less likely to have health insurance. Such marginalization’s discussed above, can make current HIV prevention messages and tools inaccessible to many. There is a need for HIV prevention tools that will enable protection. A pre-exposure prophylaxis (PrEP) is an effective HIV prevention program. It involves the use of HIV treatment medications to protect uninfected individuals from the infection and has been shown to prevent the infection by up to 92% (Philpott, 2013). The issue is that the prevalence of HIV is high for all racial and ethnic minorities, non-minorities, including men and women. There are two aspects of social justice; population-level health improvement and fair treatment of the disadvantaged need to be considered when developing publicly funded PrEP program. The goal is to address the needs of the disadvantages and vulnerabilities of the community in order to provide better health (Philpott, 2013).

Ethical Issues

There are various ethical issues that need to be considered in regards to HIV. Treatment of women with HIV has raised various ethical issues, calling for the need to have a concrete understanding about ethical decision making to aid in ensuring that arising problems are dealt with in a manner that is morally appropriate.

The ethical issues mainly involve “the standard of care, informed consent across cultures, privacy and confidentiality, stigma and discrimination, protection of vulnerable groups, community consultation, ethical review mechanisms, international collaboration, epidemiological studies, clinical trials, and sociobehavioural studies” (Hlongwa, 2016). Confidentiality is important and because of the sensitivity of information related to HIV, the laws of the U.S. offer additional protection to medical records that are HIV-related (Hlongwa, 2016). In the U.S., patients with HIV can apply for Medicaid. However, there is a stigma associated with Medicaid, being undereducated and poor. Patients with HIV deserve to be treated with the same respect and receive judgment-free healthcare.

Action Plan

To achieve successful prevention of HIV, there is a need to challenge discrimination and negative attitudes faced by individuals who are HIV-infected, affected, or are at risk of acquiring the infection. As a provider, there are actions that can be taken to make a difference in the community. It would be crucial to create an environment that empowers women and makes women feel comfortable and safe to talk about the associated risk of acquiring HIV. Women should have access to testing services, care, and be able to disclose the HIV status without fear of being judged or discriminated as a way of combating the spread of HIV. It calls for joined efforts to challenging the stigma women face as well as their sexual behaviour to aid making the feel nurtured, accepted and respected. The following are actions plans that providers can take to address this marginalized group.

1. Conducting risk screening for HIV can be used to identify patients who should receive more in depth risk assessment and HIV risk reduction counseling, interventions, or referral for other services. Screening should be made a routine part of all patients healthcare, probing for behaviors associated with transmission of HIV and other STDs, eliciting patient reports of symptoms, and laboratory testing. A measurable outcome would be to decrease the incidence of HIV within the community (CDC 2017).

2. As provider, increasing access to care and improving health outcomes for people living with HIV should be implemented in practice. Providers should develop a trusting relationship with their patients in order for patients to open up and speak freely about their needs. Providers should develop a rapport with all patients and understand that the diagnosis of HIV is a sensitive topic and should be approached honesty and respect. Care and support is important in order to facilitate immediate access to treatment when a person is diagnosed with HIV, to support adherence to treatment in order to attain viral suppression, for the sake of their own health and to prevent infecting other people with HIV, to enhance the prevention and management of HIV related infections, and to enhance coping with the challenges of living with HIV (UNAIDS.org). A measureable outcome would be to heighten women’s mentality on the subject and decrease negative judgment and stigma.

3. Another plan is to reduce HIV related health disparities. Regardless of insurance, patients should be provided equal nonjudgmental care. There are resources that patients can seek in order to receive the care they need. Providers should become familiar with community services related to care and treatment in order to provide to their patients. The Affordable Care Act provides better access to health coverage and more health insurance options, including coverage for people with pre-existing conditions, broader Medicaid eligibility, more affordable coverage, lower prescription drug costs (HIV.gov). An outcome would be to provide care to more patients who have limited access to health care and limited insurance coverage.

Conclusion

Women who are HIV-infected still face heightened levels of discrimination and isolation in society and this further contributes to the deterioration of their health among other associated problems. This paper identified women infected with HIV as one of the marginalized groups in the society. This paper discussed an overview of the marginalized group, demographic and epidemiologic data (incidence and prevalence), and economic aspects, social justice relates to the healthcare and health disparities of the group, ethical issues, and a realistic plan on how to address the marginalized group. There is a need to prevent stigma and ensure healthcare services are affordable and accessible to all with ease in order to help combat the spread of HIV infection and improve the health and wellness outcomes of this marginalized group.

Reference

AIDSVu. (2019). Local Data: Florida. Retrieved from https://aidsvu.org/state/florida/

Bertrand, T., Chan. P. A., Howe, K., Comella, J., Marak, T., & Bandy, U. (2016). Health equity, social justice, and HIV in Rhode Island: A contemporary challenge. Rhode Island Medical Journal (2013), vol. 99, 11 21-24. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5522175

Centers for Disease Control and Prevention [CDC]. (2017). HIV testing. Retrieved from https://www.cdc.gov/hiv/guidelines/testing.html

German, D., Linton, S., Cassidy-Stewart, H., & Flynn, C. (2014). Using Baltimore HIV behavioral surveillance data for local HIV prevention planning. AIDS And Behavior, 18 Suppl 3, 359-369. https://doi.org.chamberlainuniversity.idm.oclc.org/10.1007/s10461- 013-0513-1

HIV.gov. (2019). The affordable care act and HIV/AIDS. Retrieved from https://www.hiv.gov/federal-response/polcies-issues/the-affordable-care-act-and-hiv-aids

HIV.gov (2017). U.S. statistics. Retrieved from https://www.hiv.gov/hiv- basics/overview/data- and-trends/statistics

Hlongwa, P. (2016). Current ethical issues in HIV/AIDS research and HIV/AIDS care. Oral Diseases. Retrieved from https://onelinelibrary.wiley.com/doi/epdf/10.1111/odi.12391

Karbinski, Rosenberg, & Paz-Bailey. (2015). Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med, 175 (4), 588- 596.

Kontomanolis, E., N., Michalopoulos, S., Gkasdaris, G., & Fasoulakis, Z. (2017). The social stigma of HIV-AIDS: Society’s role. HIV AIDS (Auckland, N. Z.), 9, 111- 118. doi:10.2147/hiv.s129992

Paudel, V., & Baral, K. (2015). Women living with HIV/AIDS (wlha), battling stigma, discrimination and denial and the role of support groups as a coping strategy: A review of literature. Reproductive Health, 12(53). Retrieved from https://www.ncbi.nlm.gov/pmc/articles/PMC4467680/

Philphott, S. (2013). Social justice, public health ethics, and the use of HIV pre-expose prophylaxis. American Journal of Preventative Medicine, 44(12), 137-140. Retrieved from https://www.ajpmonline.org/article/S0749-3797(12)00683-6/pdf

UNAIDS.org. (2019). The importance of HIV care and support services. Retrieved from www.unaids.org/een/resources/presscentre/featurestories/2016/december/20161202_HIV -care