Beruflich Dokumente
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HIV/AIDS
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HIV/AIDS 2
Abstract
This research paper discusses the epidemiology of HIV/AIDS, the importance of the
topic, its laboratory diagnosis, prevention interventions, and response of the U.S government.
the Centers for Disease Control and Prevention (CDC) including the incidence, diagnosis, and
deaths caused by the epidemic. Moreover, persons and populations that HIV have infected are
also discussed. The Laboratory diagnosis segment will discuss the diagnosis of HIV/AIDS
among people and groups in the United States. Biomedical, behavioral, population-level, and
structured interventions are effective preventive interventions used in the United States. The
response of the US government towards the epidemic will also be discussed to understand how
Introduction
Over the past few decades, there has been an upsurge regarding the study, prevention,
and control of the HIV epidemic in the USA. According to Fauci et al (2019), HIV/AIDS has
claimed more than 70,000 lives in the country since 1981 when it was first described. The CDC
indicate that approximately 1.1 million people are living with HIV/AIDS in the USA and 6
dependent areas (Fauci et al., 2019)The government of the United States has, in response,
developed and adopted various intervention measures to combat HIV/AIDS. The use of different
screening procedures to detect HIV/AIDS has been significant in developing various intervention
prevent and manage the spread of the epidemic. Given the negative impacts of HIV/AIDS to the
people and the economy of the U.S, educating masses about the topic is important in creating
awareness and influencing behaviors (Kuchenbecker, 2015). This research paper discusses the
epidemiology of HIV/AIDS, the importance of the topic to the health status of Americans, its
laboratory diagnosis, prevention interventions, and the response of the United States government
to the epidemic.
Epidemiology
Today, approximately 35 million individuals are living with HIV in the world and the
United States of America accounts for 3.5% of this population ("Centers for Disease Control",
2019). This part of the research paper will discuss the HIV epidemiology in the US.
Incidences
According to Castel, Magnus, and Greenberg (2015) HIV incidence is defined as the
projected number of persons who are infected with HIV in a particular year. Having knowledge
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about the incidence, location, and populations in which new infections are more prevalent
ensures prevention measures are targeted towards the right direction (Castel, Magnus, &
Greenberg, 2015). CDC estimates that nearly 38,700 individuals were newly infected with HIV
in 2017("Center for Disease Control", 2019). The Center for Disease Control explains that the
decline in new incidences has remained constant due to the fact that effective prevention and
management provisions of HIV are not adequately reaching people who have or at a greater risk
of getting infected, with HIV/AIDS (Castel, Magnus, & Greenberg, 2015). These prevention and
management gaps have been troublesome especially in rural America, the South, and among
The number of HIV infections by age group, between 2010 and 2016, reduced among
people aged 13-24 and 45-54 ("Center for Disease Control", 2019). New incidences increased in
the 25-34 age-group and remained constant in the 33-44 age-group, as well as among people
aged 55 years and above. By sex category, the number of new infections remained constant
among males and significantly decreased among females ("Center for Disease Control", 2019).
With regards to race and ethnicity, new incidences reduced among Whites, African Americans,
and multiracial people and remained constant among Asians and Latinos.
Based on transmission category, the number of new HIV infections reduced among
adolescents and adults whose infection were attributed to injection drug use. The number of
infections remained constant for homosexual men who also practice injection drug use ("Center
for Disease Control", 2019). By religion, the number of incidences reduced in the northeast but
Diagnoses
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According to the CDC, HIV diagnoses refers to the number of individuals who have
received a diagnosis of their HIV status in a given year, irrespective of when they were infected.
An estimated 38,789 persons in America received an HIV diagnosis in 2017 ("Center for Disease
Control", 2018). Overall, the number incidences per year remained also remained constant from
2012-2016. Nonetheless, the number of annual incidences have increased among various groups.
In 2017, The CDC reports that among all HIV diagnoses, 66% (25,748) was accounted
for by gay and bisexual men. Of all male HIV diagnoses, bisexual gay and bisexual recorded
82% ("Center for Disease Control", 2018). Moreover, African American gay and bisexual men
recorded the highest incidence of HIV (9,807). This was followed by Latinos and Whites who
accounted for 7,436 and 6,982 respectively. Between 2012 and 2016, HIV diagnoses among gay
and bisexual men remained constant although trends varied among men from different races
("Center for Disease Control", 2019). Also, the CDC report that new incidences reduced by 14%
and remained constant among Whites and Africa Americans gay and bisexual men respectively.
Heterosexuals and persons who do injection drug use also continue getting affected by
the epidemic. In 2017, they recorded 24% of all diagnosis. Out of this, heterosexual men and
heterosexual women accounted for 7% (2,829) and 16% (6,341) of new HIV diagnoses
respectively ("Center for Disease Control", 2018). Between 2012 ND 2016, HIV diagnoses
decreased by 17% among individuals who inject drugs. Based on race and ethnic groups, 43%
(16,694) of HIV/AIDS diagnoses was accounted for by African Americans ("Center for Disease
Control", 2019). Latinos recorded 26% (9,908) of the American population. HIV diagnoses
among African Americans and Whites decreased by 5% and 8% respectively and remained
Nearly 1.1 million persons are living with HIV/AIDs in the United States of America and
14% are unaware that they are infected with HIV/AIDS ("Center for Disease Control", 2018).
Young people aged between 13 and 24 years were the most unlikely to be aware of their
infection with an estimated 51%. Among all the diagnosed and undiagnosed adolescents and
adults with HIV in the United States, only 63% received medical treatment in 2015. 49% of them
were admitted in continuous HIV care, and 51% attained viral suppression
In 2017, an estimated 17,803 persons were diagnosed with Aids (stage 3) in the United
States and 6 dependent regions. In 2016, an estimated 15,809 deaths were reported among people
diagnosed with HIV. The diagnoses and mortality rate of AIDS are not equally distributed across
state regions in the country (Xu et al., 2018). Approximately 47% of HIV deaths occurred in the
South, 23% in the Northeast, and 16% in the West. Moreover, 11% occurred in the Midwest and
Importance of HIV topic to Human Health Status and why it should be studied
As mention earlier, millions of people have been infected by HIV/AIDS. However, not
all individuals are aware of the impact of AIDS among people, the community, organizations,
and the entire country. The topic is important in making people aware about the epidemic,
prevalence, level of care, and treatment to people, irrespective of whether they are living with
HIV/AIDS or caring for other people with the epidemic. Increased education programs about the
topic would be effective in equipping people with knowledge about HIV infection and which
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prevention measures to adapt to reduce the rates of infection and transmission. Moreover, the
The HIV/Aids topic should be studied since the epidemic has multiple negative impacts
that can be reduced through education and awareness. For instance, HIV/AIDS affects many
people across the country and has also lowered the life expectancy of people living with the
infection (Xu et al., 2018). Moreover, the epidemic hampers human resource development in the
United States since at least 90% of persons living with HIV/AIDS are in their working ages.
Given that HIV/AIDS has no cure and its impacts are devastating, it is important to educate
people about the topic to prevent the epidemic from spreading and negatively affecting more
lives.
According to Cornett and Kirn (2013), improved HIV testing and diagnosis could
decrease the prevalence of HIV/AIDS and help in identifying people who acquired the infection
recently. Initially, the United States recommendations for HIV screening concentrated on
screening people with involved in blood transfusion, dangerous sexual practices, STDs, and/or
injection drug use (Alexander, 2016). Nevertheless, recent HIV screening has been expanded to
include other groups of people at risk if getting infected. In relation, the launch of the Expanded
HIV Testing Initiative by the CDC has widened the access to HIV screening and led to less
undiagnosed HIV infections. Routine screening is recommended for people aged between 13-64
years in the United States (Alexander, 2016). There are three broad categories of HIV screening
tests namely enzyme immunoassays, rapid HIV tests, and HIV confirmatory tests.
Enzyme Immunoassays
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Enzyme immunoassays (EIA) are significant tests in screening HIV infections. They are
a biochemical method used to identify and measure unknown analytes in solution based on
antibody-antigen reactions (Alexander, 2016). Currently, the fourth-generation assays are more
available for use in the United States of America and 6 dependent areas given their significance
in detecting p24 antigen as well as HIV-1/2, IgG, and IgM antibodies. Fourth-generation enzyme
immunoassays have reduced the period to diagnosis to 2 weeks after HIV infection.
devices that have absorbent membranes for detecting either anti-HIV IgG or anti-HIV IgM, or
both in blood, plasma, serum, or oral fluids of people (Cornett & Kirn, 2013). These rapid HIV
tests are more effective since detecting both HIV-1 and HIV-2. Moreover, they have a
turnaround time of not more than 30 minutes making them essentially significant for people with
poor follow-up practices and laboring women. Flow-through cassettes and lateral-flow devices
have higher sensitivities and specificities that range between 99.3%-100% and 99.7%-99.9%
respectively (Cornett & Kirn, 2013). False-negative results are still a concern particularly during
the window stage of the infection and in populations at a higher risk of getting infected.
The single use of these rapid tests can be challenging for mass screening because of their
reduced turnaround time and costs. Rapid HIV tests that use oral fluid are significant in home-
based settings and settings with limited resources. They have high accuracy in populations with
higher risks of getting infected with AIDS, like persons attending STI clinics. Today, there is a
4.5 generation HIV rapid test known as the Alere Determine HIV Ag-Ab Combo, which
provides distinct results for HIV antibody and HIV antigen. Alexander (2016) indicate that this
immunoassay has an overall sesnitivity of between 99.3% and 99.7% and a specificity of 88.2%.
HIV/AIDS 9
Confirmatory Tests
Based on their high specificity levels, western blot and indirect immunofluorescence
assay (IFA) are common HIV confirmatory tests (Cornett & Kirn, 2013). The Western blot
detects antibodies that entangle on fixed HIV proteins which read positive, negative, or
indeterminate when mixed with a substrate. On the other hand, IFA mixes plasma or serum with
T cells having HIV antigens to screen for the presence of HIV antibodies. The combination of
western blot and IFA test has high sensitivity and specificity of 99.3% -99.7% and 99.7%
respectively.
Prevention of HIV
The advancement of prevention measures for HIV in the United States has evolved at par
with every scientific breakthrough about the epidemic. As a result, there is an armamentarium of
new tools to prevent and manage the epidemic. There are various preventive interventions
prevention of HIV.
Biomedical Interventions
Kuchenbecker (2015) explain that biomedical interventions require either the use of
Castel, Magnus, and Greenberg (2015) point out that the necessity to slow down the spread of
the HIV epidemic has led to an increased focus on biomedical interventions. Biomedical
administration of antiretroviral therapy to both pregnant and laboring women in the United States
has been significant in reducing the transmission and spread of the epidemic.
HIV/AIDS 10
The idea that ART can be used in preventive interventions led to the introduction of
other preventive measures for uninfected as well as infected persons such as post-exposure
prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). Castel, Magnus, and Greenberg (2015)
explain that post-exposure prophylaxis (PEP) is a biomedical intervention used after exposure to
HIV to decrease the chances of contracting HIV. Further, there is non-occupational PEP (nPEP)
used after high sexual risk exposures (Castel, Magnus, & Greenberg, 2015). PrEP is used by
individuals who do not have HIV to decrease the risks of getting infected. According to research,
PrEP accounts for 44% reduction in the spread of HIV among transgender women and
homosexual men (Castel, Magnus, & Greenberg, 2015). Other biomedical interventions include
the use of gel microbes and vaginal rings. In the future, biomedical interventions might include a
combination of behavioral, structural, and biomedical interventions that are effective for a
Behavioral Interventions
various behavioral methods (Kuchenbecker, 2015). The sexual transition of HIV/AIDS could be
significantly prevented through abstinence, faithfulness, and the use of condoms. Kuchenbecker
(2015) explains that the main objective of using behavioral interventions has been to decrease
risk behaviors that could lead to HIV/AIDS infection. Other interventions include counseling to
encourage testing, know-your-status programs, and awareness to sexual partners using peer and
Population-level Interventions
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Castel, Magnus, and Greenberg (2015) explain that challenges that may impede the use
facilities, improving the diagnosis and management of STIs, and promoting cultural competency
among healthcare providers (Castel, Magnus, & Greenberg, 2015). Reducing stigma, improving
access to healthcare, and improving the diagnosis of STIs as well as their management could
encourage many people to visit healthcare facilities to seek advice or treatment for their health
status. Other population-level interventions such as reducing medicals costs associated with HIV
and monitoring patients are also commonly used in many states across the United States.
Structural Interventions
Structural medical interventions are employed by changing the context within which
health care is provided. According to Castel, Magnus, and Greenberg (2015), the adoption of
routine testing, irrespective of known symptoms or risk factors, in emergency units and
departments has been significant in the prevention of HIV/AIDS in the United States given their
ability to reach people who do not want to disclose any risk behaviors. The development of
syringe exchange programs and monitored injection facilities are also effective structural
interventions used to reduce the spread of HIV among injection drug users (Castel, Magnus, &
significant prevention measure incorporated in the United States health guidelines to prevent
HIV. TasP prevention intervention and programs incorporate the use of antiretroviral treatment
Fauci et al (2019) indicate that both the federal and state governments in the United
States of America have developed various provisions and interventions for dealing with the
HIV/AIDS epidemic. Governments in the county have enacted laws, allocated resources, and
developed infrastructure to handle HIV/AIDS. In the 2019 financial year, the federal
government allocated an estimate of $34.8 billion dollars to fight HIV. Out of this, $28 billion
was allocated for domestic efforts to combat the epidemic in which $21.5 billion was dedicated
to caring, $3.1 for cash and housing needs, $2.6 billion for research on HIV/AIDS, and $0.9
HIV/AIDS. Various government programs that focus on health insurance coverage, support, as
well as care to persons with HIV/AIDS include Housing Opportunities for Persons with
HIV/AIDS Program (HOPWA), Medicare, and Medicaid. Moreover, the Centers for Disease
Control and Prevention (CDC), in partnership with state and federal health departments,
conducts surveillance, prevention, and treatment activities (Fauci et al., 2019). The Affordable
Care Act (ACA) has been effective in combating HIV/AIDS. Since its enactment in 2010, ACA
has provided opportunities for increasing health care access, prevention, and management
services for people with, or at risk of getting, HIV/AIDS (Fauci et al., 2019). The government
also has new protections and non-discrimination regulations in place for equitable access to
healthcare.
Conclusion
The epidemiology of HIV/AIDS in the United States of America indicate that the
incidences of HIV/AIDS have either remained stable or decreased over the past few years.
Nevertheless, the number of new diagnoses has reduced and remained stable among many
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groups of people. Various diagnosis tests and prevention measures have been developed to assist
in preventing and managing the spread of HIV. Moreover, the government of the USA has
allocated funds for combating HIV. Moreover, it has formed agencies and enacted new
provisions in the law to protect people living with aids and ensure they have equal access to
medical care.
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References
Castel, A. D., Magnus, M., & Greenberg, A. E. (2015). Update on the epidemiology and
Centers for Disease Control and Prevention (CDC). (2018). Diagnosis of HIV infection in the
United States and dependent areas, 2017. HIV Surveillance Supplemental Report, 23(4).
Centers for Disease Control and Prevention (CDC). (2019). Estimated HIV incidence and
Cornett, J. K., & Kirn, T. J. (2013). Laboratory diagnosis of HIV in adults: a review of current
Fauci, A. S., Redfield, R. R., Sigounas, G., Weahkee, M. D., & Giroir, B. P. (2019). Ending the
HIV epidemic: a plan for the United States. Jama, 321(9), 844-845.
Xu, J., Murphy, S. L., Kochanek, K. D., Bastian, B., & Arias, E. (2018). Deaths: Final data for
2016.