Trends In Epidemiology Of Hiv Health And Social Care Essay

Zimbabwe has the 3rd largest HIV load in Southern Africa with an estimated 1 million grownups aged 15 and above and 150,000 kids under 15 life with HIV ( 1 ) . Harare, the state in which the capital is located, accounting for largest proportion of people populating with HIV in the state ( merely under 20 % ) and Bulawayo, the state ‘s 2nd largest metropolis accounting for the smallest proportion ( merely over 5 % ) .

Zimbabwe has a generalized HIV epidemic, with exceptionally high degree of HIV prevalence in the yesteryear and significantly lower degrees at nowadays. It is estimated that between 1998 and 2010, grownup HIV prevalence has halved from 27.2 % to 14.3 % . ( 2 ) The epidemic in Zimbabwe has contracted faster than any other HIV epidemic in Eastern and Southern Africa as Figure 1 ( 1 ) below illustrates:

Figure 1: HIV prevalence curves from East and Southern Africa

The contraction in HIV prevalence is attributed to really high mortality every bit good as important alterations in sexual behavior ( 1 ) . During the economic system crisis Zimbabwe faced, the wellness system collapsed to widen that most HIV septic persons died due deficiency of antiretroviral drugs and installations for intervention of timeserving infections. In footings of behavior alteration informations from the Population Services International ( PSI ) studies conducted in 2001, 2003, 2005, 2006, and 2007 support this decision, particularly with respect to spouse decrease. For work forces 15-29, the proportion describing non-regular spouses fell from 32 % in 2001 to 21 % in 2003, and remained near that degree through subsequently PSI studies. For adult females 15-29, the estimations were for a decrease from 17 % to 8 % in the same period.

Zimbabwe is geographically distributed into 10 states. In contrast to other states in the part, the Zimbabwean HIV epidemic is geographically rather homogeneous with similar HIV prevalence degrees across states ( Figure 2 ) . Geographic homogeneousness besides applies when HIV prevalence in rural and urban zones is compared: Rural and urban occupants have similar odds of being HIV infected ( 17.6 % in rural vs. 18.9 % in urban countries ) . There may nevertheless be important heterogeneousness in HIV prevalence at a local degree, as noted in really different degrees of HIV prevalence among Antenatal Clinic clients, with peculiarly high HIV prevalence degrees among those occupant in relocation farms, growing points, main road and boundary line towns ( 3 ) .

Figure 2: Adult HIV prevalence by state in Zimbabwe Source: Zimbabwe Demographic Health Survey 2005/6.

In Zimbabwe grownup HIV prevalence harmonizing to sex is significantly higher among adult females aged 15-49 ( 21 % ) than among work forces in the same age cohort ( 14.5 % ) ( 4 ) . This gender spread is even wider among immature people. Females aged 15-19 old ages have significantly higher HIV prevalence rates than work forces among the same age group ( Figure 3 ) .The differential between female and male prevalence is big besides in the age groups 20-24, 25-29 and 30-34 old ages reflecting both historical transmittal forms and important degrees of age disparate sexual relationships. The peak age for HIV infection in adult females is 30-34 old ages while for work forces it is the 40-44 old ages age group.

Figure 3: HIV prevalence by age and sex in Zimbabwe

Beginning: 2005/6 ZDHS, Table 14.3

In 2007, an estimated 63,247 grownups acquired HIV. However, in 2009 it is estimated that this figure rose to 66,156 ( about 182 new HIV infections daily ) ( 5 ) . HIV incidence is estimated at 0.85 % in 2009. Projections into the hereafter, based on current HIV prevalence, population growing and antiretroviral therapy use indicate that the figure of freshly infected grownups will go on to turn. Heterosexual sex within unions/regular partnerships histories for the majority of beginnings of new grownup HIV infection in Zimbabwe. Other beginnings of new infections include insouciant heterosexual sex and sex work

The UNAIDS Modes of Transmission ( MoT ) theoretical account was used to pattern beginnings of new infections, and overall incidence. The MoT modeling exercising confirmed that heterosexual contact remains the chief manner of transmittal in all countries of Zimbabwe, but this was represented by several different state of affairss including both insouciant and long term partnerships and miscellaneous grades of transactional sexual relationships. Nationally, the theoretical account estimates that the bulk of new infections occur among people in the general community who are non prosecuting in high hazard sexual activities. Persons in this hazard class are in discordant, monogamous relationships of at least a twelvemonth ‘s continuance but frequently longer ( 6 ) .

Mother to child transmittal ( MTCT ) continues to stay a important beginning of new infections among babies. Approximately 1 in 3 babies born to HIV septic female parents are infected. HIV infection from an HIV-positive female parent to her kid during gestation, labor, bringing or breastfeeding is called mother-to-child transmittal ( MTCT ) . The per centum of babies born to HIV septic female parents who are HIV infected has remained high averaging 28.5 % between 2006 and 2009. An estimated 15,000 kids were freshly infected with HIV in 2009 ( 5 ) , the huge bulk of them through MTCT.

Describe how HIV/AIDS Surveillance informations are collected and sketch the advantages and restrictions of these informations aggregation attacks.

The aggregation of informations for HIV prevalence informations is really important for national HIV & A ; AIDS programmes particularly in footings of policy devising. There are several methods used but I will depict Antenatal Clinic Surveillance and Population Based Surveys sketching the advantages and restrictions of each.

Antenatal Clinic Surveillance

The chief intent of surveillance based on adult females go toing prenatal clinics is to measure tendencies in HIV prevalence over clip. However, because other informations beginnings are missing, prenatal clinic surveillance has besides been used to gauge the population degrees of HIV. This is normally based on anon. , unlinked, cross-sectional studies of pregnant adult females go toing prenatal clinics in the public wellness sector. Merely first-time attendants are included to minimise the opportunity of any adult female being included more than one time. Blood is taken routinely from pregnant adult females for diagnostic intents which include poxs, Macaca mulatta and blood grouping. After personal identifiers are removed the blood is tested for HIV. Antenatal clinic studies are normally done yearly at the same clip of the twelvemonth to obtain an estimation of the point prevalence for that twelvemonth. The national HIV prevalence of a state is frequently 80 % of the prevalence rate in pregnant adult females go toing prenatal clinics ( 7 ) .

Advantages of Antenatal Clinic Surveillance

Prenatal clinics provide ready and easy entree to a cross-section of sexually active adult females from the general population who are non utilizing contraceptive method.

In generalised epidemics, HIV proving among pregnant adult females is considered a good placeholder for prevalence in the general population ( 7 )

Data for pregnant adult females will reflect the prevalence in groups that may be of higher hazard of infection because of their life agreements ( such as workers who live in inns or ground forces barracks ) if they have regular unprotected sexual contact with adult females in the general population.

The restrictions of prenatal surveillance are recognized and acknowledged, and where possible, rectification factors have been developed to get the better of some of the restrictions. In states with low degrees of HIV prevalence, strategically placed lookout sites can supply an early warning for the start of an epidemic. ( 8 )

In recent old ages, many states have expanded the geographical coverage ( the figure and sample sizes of sites ) of lookout surveillance, particularly in rural countries, to better the representativeness of the samples.

Restrictions of Antenatal Clinic Surveillance

Most sentinel surveillance systems have limited geographical coverage, particularly in smaller and more distant rural countries.

Womans go toing prenatal clinics may non be representative of all pregnant adult females because many adult females may non go to prenatal clinics or may go to private clinics. The rate of preventive usage in a state may impact the figure of pregnant adult females.

The execution of prenatal clinic-based surveillance varies well between states ( 9 ) . The quality of the studies may change over clip depending on available resources.

Antenatal clinic surveillance does non supply information about HIV prevalence in work forces. Because these studies are conducted among pregnant adult females, estimations for work forces are based on premises about the ratio of male-to-female prevalence that are derived from community-based surveies in the part. However, this ratio varies between states and over clip.

Population-Based Surveies

The restrictions of prenatal surveillance systems with regard to geographical coverage, under-representation of rural countries and the absence of informations for work forces have led to an involvement in including HIV proving in national population-based studies. Population-based studies can supply sensible estimations of HIV prevalence for generalised epidemics, where HIV has spread throughout the general population in a state. However, for low-level and concentrated epidemics, these studies will undervalue HIV prevalence, because HIV is concentrated in groups with bad behavior and these groups are normally non adequately sampled in household-based studies. Some early studies were designed for unlinked anon. testing, in which the HIV trial consequences could non be linked to persons, whereas more recent studies have incorporated linked anon. testing, in which HIV trial consequences can be linked to behavioral informations without uncovering the individuality of any person who has been tested.

Advantages of Population Based Surveies: –

In generalised epidemics, population-based studies can supply representative estimations of HIV prevalence for the general population every bit good as for different subgroups, such as urban and rural countries, adult females and work forces, age groups and part or state ( 8 ) .

The consequences from population-based studies can be used to set the estimations obtained from sentinel surveillance systems.

Population-based studies provide an chance to associate HIV position with societal, behavioral and other biomedical information, therefore enabling research workers to analyze the kineticss of the epidemic in more item. Information from this analysis could take to better plan design and planning.

Restrictions of Population Based Surveys.

In population-based studies, trying from families may non adequately represent high-risk and nomadic populations. In low-level or concentrated epidemics, population-based studies hence underestimate HIV prevalence.

Nonresponse ( either through refusal to take part or absence from the family at the clip of the study ) can bias population-based estimations of HIV. ( Roll uping information on nonresponders can assist in the procedure of seting for nonresponse. )

Population-based studies are expensive and logistically hard to transport out and can non be conducted often. Typically, these studies are conducted every 5-10 old ages ( 8 ) .

Outline the major factors doing spread of HIV/AIDS in the community where you live or work.

The followers are some the factors which have been attributed to distribute of HIV in Zimbabwe

Multiple Concurrent Partners ( MCP ) is by and large defined as a sexual behavior characterised by holding more than one sexual spouse in the same clip period. Zimbabwean work forces are more likely to hold multiple spouses than adult females. Harmonizing to the Zimbabwe Demographic Health Surveys 2005-6 ( ZDHS -2005-6 ) , 1 in 10 adult females and 1 in 3 work forces aged 15-49 old ages who had sex in the 12 months predating the study had sex with two or more spouses.

Low and inconsistent degrees of rubber usage, particularly among married twosomes. There is by and large a low degree of rubber usage in Zimbabwe, although the more insouciant the sexual brush, the more likely that a rubber is used due to increased hazard perceptual experience. Harmonizing to the ZDHS ( 2005-6 ) , rubber usage is last amongst married twosomes and those with long-run spouses with merely 3.6 % of married adult females and 7.7 % of work forces describing utilizing rubbers the last clip they had sex with a partner or cohabiting spouse. Harmonizing to a survey by SAFAIDS about 52 % of all new infections which occurred in 2009 occurred among married people which makes the matrimony a hazard brotherhood.

Low Levels of Male Circumcision: Male Circumcision is one of the best ways that has been seen to forestall HIV transmittal by about 60 % harmonizing to three surveies carried out in the different states in Africa: – Rakai, Uganda ( 10 ) ; Kisumu, Kenya ( 11 ) and Orange Farm, South Africa ( 12 ) . Male Circumcision has been seen to work through the undermentioned mechanisms: –

Decrease of surface country by taking the prepuce which has seen to advance entry of HIV virus.

Hardening of open glans penis therefore cut downing scratchs and hazard of HIV incursion.

The removed prepuce agencies, HIV can no longer be trapped underneath therefore minimising transmittal.

However male Circumcision in Zimbabwe remains low with 10.5 % of work forces aged 15-54 coverage being circumcised in the 2005/6 DHS. Such a low degree is improbable to impact overall HIV transmittal to any of import grade. In Zimbabwe, harmonizing to mathematical modeling ( Figure 4 ) , the figure of new HIV infections will drop significantly if male Circumcision services are expanded. The modeling is assuring and what needs to be done is to supply more consciousness and still negative attitudes.

Figure 4: – Zimbabwe Projected New Infections Cases with Male Circumcision

Adapted from a presentation by Karin Hartzold, PSI, Zimbabwe, 2010

Age disparate sexual relationships: Surveies indicate that relationships between immature adult females and older work forces are common and tolerated in Zimbabwe as in many parts of sub-Saharan Africa and are associated with insecure sexual behavior and increased HIV hazard as informations from the 2005-6 ZDHS indicates. In such relationships rubbers use tends to be selectively and strategically and such use additions HIV hazard.

High degrees of Sexually Transmitted Infections: Sexual transmitted Infections increase the hazard of HIV infection. This hazard is much higher with ulcerating infections like pox and herpes simplex. The prevalence of sexually transmitted infections in Zimbabwe is really high and this has been lending a high prevalence rate. In Zimbabwe the 2009 ANC Sentinel Surveillance Report showed that adult females with current or past venereal ulcer disease ( GUD ) had about three times the HIV prevalence of adult females without a history of GUD. Among immature ANCs aged 15-24, those with GUD had a HIV prevalence of 31 % . This is corroborated by ZDHS 2005-6 that found that work forces and adult females who reported a recent STI were significantly more likely to be HIV positive, harmonizing to the 2005/6 DHS. 40 % of adult females who reported holding had an STI or STI symptoms in the old 12 months were HIV-infected, compared to 24 % who did non describe an STI or STI symptom. For work forces, the corresponding HIV prevalence figures were 32 % and 18 % .

Other factors: – though the above factors are the taking 1s in footings of distributing HIV & A ; AIDS in Zimbabwe other factors like poorness, migratory labour systems with household breaks, commercial sex workers, low position of adult females due to gender favoritism and male laterality still play a important proportion in footings of advancing HIV transmittal.