Running head: HIV/AIDS 1

HIV/AIDS

Name of Student

Institutional Affiliation
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 epidemiology of HIV/AIDS is discussed based on Health Surveillance Reports presented by

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

the government has strived to prevent and control HIV/AIDS in America.

Keywords: HIV/AIDS, epidemiology, interventions, prevention, immunoassays,

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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

practices such as biomedical, behavioral, population-level, and structured interventions to

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

Africa Americans and Latinos populations.

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

remained constant in the West, South, and Midwest.

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.

Incidences increased by 12% among Latino gay and bisexual men.

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

stable for Latinos between 2012 and 2016.

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People Living with HIV

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

AIDS Diagnoses and Mortality

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

only 2% in the dependent areas.

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

topic is also important in encouraging people to know their status.

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.

Laboratory Diagnosis of HIV

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.

Rapid HIV Tests

Rapid HIV antibody tests comprise of either flow-through cassettes or lateral-flow

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

namely biomedical, behavioral, population-level, and structural interventions applied in the

prevention of HIV.

Biomedical Interventions

Kuchenbecker (2015) explain that biomedical interventions require either the use of

treatment medications or technologies that encourage continuous administration of medication.

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

interventions to reduce HIV infections attributed to mother-to-child transmission involve the

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.
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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

specific individual or population.

Behavioral Interventions

HIV/AIDS is a sexually and parentally transmitted illness that can be prevented by

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

mobile health care programs.

Population-level Interventions
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Castel, Magnus, and Greenberg (2015) explain that challenges that may impede the use

of behavioral and biomedical intervention measures may be effectively handled using

population-level interventions. Examples of population-level interventions used in the prevention

of HIV/AIDS include reducing stigma, improving access to healthcare professionals and

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, &

Greenberg, 2015). Moreover, treatment as prevention otherwise also known as TasP is a

significant prevention measure incorporated in the United States health guidelines to prevent

HIV. TasP prevention intervention and programs incorporate the use of antiretroviral treatment

(ART) to reduce the risk of the spread and transmission of HIV.

The United States Government Response to HIV/AIDS

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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

billion for prevention.

Moreover, multiple federal departments and agencies take part in responding to

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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