HIVand Current Preventive Measures
Jean S. Ayissi Essono
Missouri State University
Abstract
This paper discuss how HIV/AIDS can be prevented using among other methods condoms, peer education, postpartum care of childbearing mothers after delivery to reduce transmission to their newborns, politics to influence the course of its spread and the living arrangement of HIV/AIDS positive older adults in regard to socioeconomic status of their country. The literature was done using keywords such as: HIV, And, Preventive, Measures. The years of study was limited to recent five years from 2005 to 2010 and most of the studies (8 out of 10) reviewed were done in 2009 and the rest in 2008. 40 studies were found during my search using Academic Search Premier database. This topic is significant in many points such as education on HIV/AIDS to prepare medical and nursing students who are to care for the patients, important to current practitioners in order for them to refresh their knowledge and practice in the matter and finally for the society and the world at large to stop this disease which is causing a huge loss of workers and money. This literature reports on the reduction of the spread of HIV/AIDS by using preventive measures, and the finding resulting from it is that the measures are effective as long as all the parties impacted by the pandemic are involved and a holistic approach is used in the resolution of health care deficit created by the infection.
HIV and Current Preventive Measures
The United Nations Program on HIV/AIDS (UNAIDS) states that HIV is a hurdle to the achievement of global health objective—health for all—because it is decimating the upbringing or the future generation of the world. HIV is a problem precisely in Africa with a prevalence rate of 54% when compare to cases across the other continents. Also, UNAIDS further said that the virulence of HIV in 2005 yielded 3 million deaths regardless of age or sex characteristics (Charles et al, 2008). One can ask what practices the individuals use when having sex are or what are their perceptions of HIV/AIDS.
In light of the study conducted in Nigeria, the researchers noticed that individuals were using risky sexual behavior such as improper uses of condoms, unlikeliness of limiting their sexual activity with one partner, or rejection of the use of condom since they believe it is a barrier to experiencing full pleasure. Some practices in some villages, such as creating superficial incisions on the skin with razors, were among non-sexual behaviors that can explain why the prevalence of the disease is high in Nigeria and across Africa (Odu et al, 2008). Another study conducted in Mexico shows that high infectivity of HIV among homosexuals and persons posing as members of the opposite sex is due to the lack of preventive programs that take into account the needs of this population. Mexico and Latin American countries being one of the bastions of the Roman Catholic faith in the globe might also explain the rejection of these individuals’ way of life (Infante, Sosa-Rubi and Cuadra, 2009). Whereas the above studies imply an ineffectiveness of practices in scaling down the prevalence of HIV/AIDS, a study in Rwanda conducted by Jessica E. Price, Jennifer Asuka Leslie, Michael Welsh and Agnes Binagwaho in 2009 found that the incorporation of HIV/AIDS preventive services in nursing centers such as Primary Health Care and other health care settings has improved the health of individuals in the sense that many patients who were sick or not able to access the preventive measures anywhere and anytime. This is especially true for the HIV/AIDS positive patients from deep rural areas where it was difficult to access the care. Also the non-HIV/AIDS positive patients were able to know more about the disease and the way it transmits to a host (Price et al, 2009). The success of this program in Rwanda might lead one to think about the procedure of acquiring information and tools for preventing HIV/AIDS.
Procedures on how individuals who are sick or healthy gain access to HIV/AIDS preventive measures or on how governments and programs toward HIV/AIDS provide these measures vary in regard to culture, economic status of individuals and the governments. It also varies in regard to the means of transportation of information or individuals. For instance, a study conducted in Cape Town, South Africa, shows that the government has set what the researcher calls “Sexual Reproductive Health services” (Orner et al, 2008., p 1217), which are the meeting points between HIV/AIDS patients and health care professionals where treatment protocol of the disease is implemented. Some informants, unlike others, were not satisfied with this procedure based on the fact that the total quality management was not proving its effectiveness and efficiency (P. Orner et al, 2008). A study conducted in Tanzania shows that the government, in order to be effective in the fight against HIV/AIDS, has to design precise, concise and specific programs targeting the “young adults” who have a high risk for contracting the disease (Charles et al, 2009).
In Fundamentals of Nursing, Perry and Potter present Neumann’s theory, which is as follows: “the goal of Nursing is to assist individuals, families, and groups in attaining and maintaining maximal level of total wellness by purposeful interventions” (Fundamentals of Nursing, 7th ed, p 49 Table 4-1). Thus this study is significant to the nursing practice because nurses will plan the appropriate care needed for the target population toward reducing the HIV prevalence and incidence within a community and among the population at risk. A nurse, knowing that individuals in Nigeria use razors blade to puncture their skin, will negotiate with these villagers to adopt a sterilized method of puncture that will help them keep their traditional ritual while preventing the spread of HIV; thus what Stanhope and Lancaster call “cultural repatterning” is met (Stanhope & Lancaster, 2008, p 151-152). Also this is pertaining to the nursing practice because it helps nurses to assess the approaches suitable to the patients’ encounter; for example, nurses can ask themselves if the public approach is more effective in combating the infectivity of HIV or is it the primary care type necessary for that, or is it both. Because the study conducted in Mexico reveals that the government was not engaged in the treatment and care of homosexuals and persons posing as members of the opposite sex instead the non-profit organizations and other private entities were more effective at tackling the infectivity within this vulnerable population (Infante et al, 2009).
There are times when an individual has to think about his/her life and the lives of others. Some people were deeply touched by the loss of their siblings or parents due to HIV/AIDS, which has let them be conscious of the disaster and decide to take actions so that their siblings or significant others will be remembered. Ways of doing this are to campaign for awareness of the disease, to fundraise for the researches to find a definite cure of the disease, etc. The researcher writing this paper is trying to let the world and any reader know that HIV/AIDS took away his beloved older sibling, and a way to remember him is to promote the fight against this disease so that any readers will be encouraged to take action in preventing themselves and others on the researcher’s siblings’ behalf from contracting HIV/AIDS. Having said that, the purpose of this practice is to show the effectiveness of preventive measures of HIV/AIDS, and therefore show the benefits any individual has to gain if he/she decides to practice these preventive measures.
Method
Inclusion and Exclusion Criteria
Inclusion criteria included the following:
· The articles with measurable outcomes and identifiable goals.
· The researches done in low-income countries such as African countries and Mexico were selected.
· The researches that were done from 2005-2010 were selected.
Exclusion criteria included the following: the researches that were done before 2005, peer reviews articles and researches done in advanced countries were not selected.
Summary of Articles
The first article is called “Evaluation of uptake and attitude to voluntary counseling and testing among health care professional students in Kilimanjaro region, Tanzania.” Charles et al conducted their research at KCM College and other affiliated allied Health Schools at KCM in Moshi Urban district, Kilimanjaro region of North Eastern Tanzania (2009). The study population is composed mainly of the professional students seeking degrees at KCM with ages ranging from 18-25. The period of study is April through May 2005. The study question here is to correlate the willingness to follow counseling and programs of HIV/AIDS and the improvement of a safe sexual life.
The second article is called “Sex work in Mexico: vulnerability of male, travesti, transgender and transsexual sex workers.” Infante et al conducted their research in Mexico City, Mexico, between November 2006 and May 2007 (2009). The study was conducted among homosexuals and persons posing as members of the opposite sex. The study question here was to explore and describe the milieu in which these groups of people live and how their infectivity to HIV correlates to the society’s perception and bias toward these populations. The result was that, as long as these clients remain in this type of sexual life and behavior, they cannot be sustained by a society where homosexuality and other non-traditional forms of sexual life are considered evil.
The third article is called “Knowledge, attitudes to HIV/AIDS and sexual behaviour of students in a tertiary institution in south-western Nigeria.” Odu et al conducted their study in Nigeria, in the Osun’s state and the city of Ede; this study was conducted within the period of January through March 2005(2008). The study population consisted mainly of 368 students of male and female gender. The study question here was to assess the students’ awareness of HIV/AIDS and its methods of prevention; the response to this question was that students do not practice what they already know about the HIV/AIDS and preventive measures already known or acquired.
The fourth article is called “Clients' perspectives on HIV/AIDS care and treatment and reproductive health services in South Africa.” Orner et al conducted their study in Cape Town, South Africa, in 2005, and the study’s population was composed of 62 patients attending HIV/AIDS care centers (2008). The study question here was to estimate the satisfaction of respondents in regard to care and treatment received in the present and past HIV/AIDS centers. The result here shows that, while some men and women praised the services to care about and for them, others were indifferent or unhappy with the services received, and some suggestions were proposed to enhance or improve the care.
The fifth article called “Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects.” Price et al conducted their research in 14 Rwanda’s districts in the period of June 2006 (2009). The study’s population here was 30 primary health care facilities. The study question was to know whether the focus in HIV/AIDS funding is conducive to the decline of the overall quality of care delivered by the health care system to non-HIV patients. The conclusion was that there is no negative impact of HIV/AIDS programs in non-HIV/AIDS care and treatment; rather, individuals seeking non-HIV/AIDS care were well informed and likely to practice safe and healthy sexual life.
Literature search description
The infectivity of HIV in Africa alone cumulates to 71% of world’s HIV-infected individuals and at the continental level, it causes massive loss of human resources needed for the development of Africa. To counteract this effect, preventive measures are put in place since the first discovery of the HIV in humans in 1980 to reduce the negative impact of the disease (Charles et al, 2009). The persistence of the infectivity in Africa might put into question the effectiveness of these preventives measures. In light of five literature reviews, we will attempt to discuss the effectiveness of these preventive measures.
In a study conducted by Bendavid and Bhattacharya (2009), the purpose was to estimate the impact of AIDS’s policy adopted by the world’s Presidents in combating the disease. It was designed to examine the similarities and differences of the course of HIV/AIDS before and after the launch of The President’s Emergency Plan for AIDS Relief in Africa (PEPFAR). According to the study, the sample population and size was composed of 12 African countries−experimental sample, and 29 control countries. From the sample and sample size, it is obvious that the setting is African’s continent and the datum was either collected from vital statistics of an experimental country or from the United Nations Program on HIV/AIDS (UNAIDS) who monitor the pandemic in Africa. The changeable end result of the study was country and year epidemiologic data gained from UNAIDS. The statistical tests and findings were the fix-effects model for longitudinal data with fixed time and country effects. And the findings here as described by the authors were that there was no difference between the control and experimental populations after the implementation of PEPFAR. Before that the experimental population was experiencing a tenth percentage loss of individuals infected with HIV than in a control group.
The strength of this study comes from the credentials the researchers have since they are all medical doctors; the study was conducted in Africa which is the pandemic zone most attacked by the disease. The study was conducted in two sequences; the ante-PEPFAR from 1997 to 2002, and post-PEPFAR from 2004 to 2007. So the time was precise in evaluating the policy effects on the prevalence of HIV/AIDS in African countries. The strength of the study is that outcomes were initiated to evaluate the results among control and experimental populations in a cross-country examination such as HIV occurrence among adults of 15 to 49 years of age, number of adults who die because of HIV/AIDS and persons living with the disease (Bendavid and Bhattacharya, 2009). There are several weaknesses of the study. One weakness is that it does not take into account policies and organizations set in place by Non for Profit institutions such as religious groups and civic ones which is a threat to external validity. Also the study forgot to consider the effects of corrupted government in the implementation of policy adopted at a continental or national level. The study results can be generalized to the world in the sense that we all know that when a group of entities lends a hand in combating a problem, they are more likely to succeed. An internal threat here can also be the fact that the health cultural beliefs of African countries cannot be transposed to Europe or America.
The second study conducted by Cheng and Siankam state the purpose as: “investigates whether socioeconomic development and the HIV/AIDS pandemic are associated with living arrangement patterns in older persons in 23 sub-Saharan African countries.” (Cheng and Siankam, 2009, p 136). The study is designed in a way that the sample population is composed of countries and the hypotheses being that the level of economic and social expansion of the sample will have a negative correlation with the living arrangement of seniors. Another hypothesis is that the occurrence of HIV/AIDS will be positively correlated with seniors living with their son/daughter’s children and negatively correlate with them living in their older adult children. The researchers use a secondary analysis since data were collected from United Nations of Statistics Division and the World Bank in 2007. The sample was not big enough to have a precise and consistent result (Cheng and Siankam, 2009). The study was conducted in Africa and the type of statistical test was the usage of least square analysis which yielded the following findings as stated by Cheng and Siankam: “neither socioeconomic nor HIV/AIDS factors contributed to the explanation of living alone….compare to men, women were more likely to be living alone, with older children, … with grandchildren only, and with other relatives.”(Cheng and Siankam, 2009, p 141).
The weaknesses of the research are not the fact that living arrangement is not considered a preventive measure of HIV in the sense that it does not address the threat of the infection and disease; nor does the socioeconomic development as it does not answer the call to fight HIV/AIDS. An alternative to this research will be to demonstrate how socioeconomic development can be a contributor to the spread of HIV/AIDS thus the results of this study cannot be generalized to other countries of the world with different cultural background and economical status. We would have wanted that the sample population be the individuals not the countries because it has driven away the concern of individuals with HIV/AIDS. One might forget the suffering of HIV/AIDS patients. The strengths of the study are that it really shows the stigma of people living with HIV/AIDS in Africa. Until now it is known that people living with HIV/AIDS in Africa are 25% likely to be quarantined by their relatives, friends and alike (Odu et al, 2008). The stigma is also found in other countries where homosexual, transgender suffer the burden of carrying HIV/AIDS in Mexico (Infante et al, 2008).
The third study by Campbell and Cornish inquires about the contributing factors to the favorable attempt to community teaching as prevention of HIV/AIDS regardless of the environment or geographic area. The study was conducted both in South Africa and India for comparison purpose. The population sample was composed of 20 sex workers in each country and these sex workers are peer educators. This research by its design is qualitative inquiry of cultural impact in a favorable termination of community teaching as HIV/AIDS prevention methods. Qualitative methods such as interviews with sex workers and their customers, and fieldwork were implemented for a period of 4 years in Summertown, South Africa. The other research took place in Sonagachi where 11 interviews and 10 group discussions were implemented in a period of 10 months. Another interview of the residents requesting service from sex workers took place and was amounted to 20. Thus the population sample here was mixed between people heavily or not involved in the program in each country (Campbell and Cornish, 2009). The findings of this inquiry suggest what Stanhope and Lancaster describe as: “Professional-client-community partnerships are important for reform to be meaningful at the local level” (Lancaster and Stanhope, 2008, p388). Thus the researchers find that engaging the residents and sex workers in the program was determinant to the health changing behavior. The involvement can be in terms of project designing, taking into account residents’ social, political and economical interests and lastly the flexibility of the persons involve in the project (Campbell and Cornish, 2009).
The study’s strengths are that they are replicable in any country regardless of the culture, political ideology, and economical advancement. It has proven that the change has to come from within not from without. Thus any project has to take into account the reality of the people and their environment to implement the change they want or, expected by others. The characteristics of the sample population are found all over the world because sex workers can be found anywhere in the world. Strength of the study is that researchers were within the living conditions of the sample population. The weakness of this study is that since the project was successful in India and failed in South Africa, the India’s reality cannot be transposed to South Africa in order to achieve a successful outcome, thus the project cannot be generalized to other countries in regard of Indian’s reality considerations.
The fourth research inquired by Dorina et al who stated that: “we report the results (… ) of a health education intervention aimed at enhancing coping skills and consistent use among HIV-positive women (…) in the Western Cape province of South Africa.” (Dorina et. al, 2009, p817). They attempt to evaluate the link between teaching prevention on one hand, and condom usage along with coping skills. The study population here was HIV-positive women speaking one of South Africa’s languages. This population was composed of 143 women from five primary care clinics to participate in the inquiry if they were 18 to 50 years old, have had sex in a year from now till then, and speak isiXhosa and are HIV positive. Based on these criteria, 120 women were selected and 23 ousted due to the fact that they have not had sexual intercourse one year prior to the study. The study was designed in regard to Nuremberg Code (1949) with inform consent provided to participants and were allow to quit if they find their interests violated. They were also given information about sterile collection of vaginal fluid and completed a questionnaire. Since they were speaking isiXhosa, researchers had to translate information into their language. Randomized selection of participants was implemented to reduce bias between the experimental and control group. Participants were given $3 for responding to the questionnaire and $75 for completing health education. Follow up of the participants during and after the research was done. The ethics commission gave the permission for the research to be conducted. The researchers analyzed primary datum from self-collected vaginal fluid by participants. Chi-squared , independent samples t, Fisher’s exact test and logistic regression analysis were used throughout the study. As findings, it was reported that health teaching was correlated to a high usage of condom and enhancement of positive self-esteem in experimental population; thus correlating that, reduction of HIV/AIDS was due to a high usage of condom and positive self-esteem which also, correlate the effectiveness of health teaching intervention in experimental group compare to control one (Dorina et. Al, 2009).
Strengths of this study derive from the fact that it was done according to Nuremberg Code of ethics (1949), strict randomization of sample to prevent bias. Conductors of the study were experts in the field, and the study can be generalized to other settings. It was culturally conducted by offering an interpreter to the participants speaking a native language. The fact that it was conducted in South Africa; which is heavily touched by HIV/AIDS can serve as experimental to other studies conducted in other geographical areas of lesser affection. The participants even though having a primary education was well trained in the collection of data and completion of the questionnaire. Weaknesses here are the fact that the study was biased in choosing just HIV-positive women speaking isiXhosa. The study period was short−three months which cannot predict if the participants can be faithful to condom usage or if they can still have a positive attitude in regard to a safe sex. The study has not planned what Nurses call “discharge planning” which will keep and reinforce the teaching, participants have undergone during those three months period.
The last and fifth study conducted by (Mercy et. al, 2009), discuss how contributing factors affect the compliance of postpartum mother with postnatal HIV/AIDS activity. Thus the study population here is the postpartum HIV/AIDS positive childbearing mothers and their newborn, who are distributed in control and experimental groups, all totaling 296 participants. 289of them were enrolled in the study because they gave their approval to be part of it unlike seven who were not. This was a qualitative study conducted by interview and fieldwork to houses of the participants after being discharge. The study took place in Mulago’s hospital which houses the Obstetric unit which is one of the top ranking in the health care system of Uganda. The study was designed as a cross-sectional method of correlating compliance to postnatal HIV care by postpartum childbearing family. The study period lasted 5 months from 2006 to 2007; time within which participants were screened when discharged from the obstetric unit. Also they were handed a questionnaire during that procedure and this questionnaire was translated back and forth into native language and English. Participants were either phone or visit at home for follow-up and evaluation of their compliance to postpartum activity. Selection was randomized to prevent bias. The control and experimental groups was each composed of 15 mothers who return for the follow up , and were selected on the basis of every 7th returnee and 10 of them participated in the focus group discussion (FGD) at the other hand, 15 who fail to show up were invited on the basis of 11th failure selection and like the returnees, 10 were selected to attend FGD. A skill person was conducting the interview of these participants using their language. A reporter was there to take notes of the session. Both descriptive statistics and multivariate logistic regression analysis were statistically useful in the analysis of data. As state by the researchers, “38% adhere to the postnatal prevention of mother to child transmission. Factors contributing to the adherence of postnatal HIV/AIDS care are described as being member of a Christian denomination, aging 25 or under, having had a prenatal HIV/AIDS testing, being married or having a friend or sibling or a lover living at home without one or no child at all (Mercy et. al, 2009).
The strengths of the study reside in the fact that the randomized selection of the population was done, and researchers and conductors of the focus group discussion were well trained, the time period (5 months for screening and 3 months for follow-up) was good enough to conduct a qualitative study. The study addresses the reinforcement of the HIV/AIDS care for maintenance and promotion of health which is a reminder to individuals that at any time, we have to set as habit the monitoring of our physical and mental health. This can be generalized to other settings and population in regard to the maintenance and surveillance of health in general and, of the childbearing family specifically. It proves that like the previous study done by Dorina et.al (2009), that an implementation of a health program has to take into account the cultural background of the community in which the study is conducted. Participants of the study were above average in terms of education which can be a limitation to the study in regard to the understanding and application of the teaching given to them during discharge, to avoid that, researchers have to incorporate an interpreter who is well educated and capable to translate back and forth the teachings and responses of the participants. Another weakness is that the reality of the Uganda’s culture is not transposable to other settings unlike quantitative study who can transpose to different settings regardless of the population or environment. The study fails to appreciate the discrepancy between the number of participants who attended ante partum HIV/AIDS activity and the number of those who attended the postpartum HIV/AIDS activity. It has not explained why participants who attended ante partum HIV/AIDS activity fail to do so in postpartum one.
Discussion
After reviewing these articles, it is obvious that Africa as stated by Mercy et. al, (2009) is the battlefront against HIV/AIDS in the world. Thus every effort should not be spared to fight the disease. We all know that, the treatments of this infection/disease rest in the prowess of pharmaceutical companies, based in wealthiest countries to find its definite cure or vaccine. The studies just assessed the preventions taken place in Africa to fight the pandemic such as the usage of condoms and attitudes toward the disease, whereas other just assessed the role of politics and cultural impact in the fight to reduce the damage caused by the pandemic. A study conducted in Uganda, assess what is done to help a childbearing mother to reduce the impact of transmission to her newborn and the impact to the well being of her family at large (Mercy et. al, 2009). Another study by Campbell and Cornish (2009) proves that involving the community in any project addressing their health is determinant to the fight against the pandemic and, by large to the reduction of other sexually transmitted disease (STD). A study by Cheng and Siankam (2009), stresses the attitude people have towards HIV/AIDS-positive older adults by correlating living arrangement of these patients to their condition and to the socioeconomic status of the country in which they live. One of these studies in South Africa assessed how a HIV/AIDS-positive woman is able to negotiate the usage of condoms giving that, her cultural background diminished her to a role of subservient thus to be dominated by her male partner(Dorina et. al, 2009). Other conducted by Bendavid and Bhattacharya (2009) assessed the effect of general policy of the governments in the fight against the pandemic. These researches fail to promote an alternative in the prevention of HIV/AIDS by failing to appreciate the effect of abstinence and fidelity in the fight against the pandemic. A holistic approach that takes into account all the possibilities should have been assessed and implemented. The pope Benedict XVI believes that HIV/AIDS can be fight successfully only if abstinence and fidelity are the core components of the prevention (Pope Benedict XVI speech text, 12/11). Abstinence and fidelity reduces the likely hood of contracting HIV/AIDS by an individual refraining to have sexual intercourse or by being faithful to only one partner. In this case, both partners have to undergo HIV test to make sure that none of them is HIV-positive before initiating the fidelity aspect of prevention. The studies should have appreciated how abstinence and fidelity reduce immoral issues such as infidelity and disharmony of the family, not to mention the cost of health care related to cure or prevention of STD and HIV/AIDS which can be a burden to the family. It should have also assessed the spiritual effect of these values in the fight against the infection.
Nevertheless, the findings of the studies are that, in regard to the application of the policy taken by the world’s presidents, a scaling down of HIV-mortality was noticeable but the course of occurrence was not (Bendavid and Bhattacharya, 2009). The second study finds that 38% of childbearing postpartum mothers adhere to postpartum HIV/AIDS care due to contributing factors such as religion, age, marital status, attendance to ante partum HIV/AIDS care (Mercy et. al, 2009). The third study finds that promotion and success of urban and rural health care in regard to HIV/AIDS prevention or any other health program is inseparable to the involvement of the residents and interests groups in the change they want to adopt (Campbell and Cornish, 2009). Cheng and Siankam (2009) find that living arrangement of HIV/AIDS-positive older adults was dependent of the socioeconomic status of the country. And that is why in wealthier countries, infected or diseased persons with HIV/AIDS live either with their wife or husband, or in a retired house like a Nursing home or with a non related family member. Whereas in lesser develop countries like in Africa, HIV/AIDS older adults are cared by their descendants. The last study finds that condom usage and positive self-esteem were determinants to lessening the spread of HIV/AIDS to non carriers. This usage has increased in the experimental group and, participants with positive self-esteem were able to face any stigma related to their status or carrying the social tasks to better their living conditions (Dorina et. al, 2009). In light of these findings, one is called to integrate a holistic approach to combat at individual and national level the spread of HIV/AIDS; this can be done by incorporating attitudes, beliefs such as abstinence and fidelity, physical methods such as condom usage and other contraceptives measures in our sexuality.
Implications for Practice and Conclusion
We all know that after a research’s results have been published, it can be utilized for academic or practical purpose or for a research critique in which the study is rescreened in terms of accuracy, validity and etc. Having said that, these studies can serve as information for students, instructors and people involve in the fight against HIV/AIDS to enhance or augment their knowledge of HIV/AIDS. It shows that like one of the studies did, any program intended to enhance the health of any individual should be approached by incorporating all the parties involve like government, residents, interests group who can make a change possible. A community Nurse can use this research for effective and efficient impact in every health activity implemented in the area. Along with community Nurse, other health care agents will attach to the usage of condom the behavior that promote the safe practice of sex such as refraining from having many partners, applying the HIV/AIDS knowledge on a daily basis such as sharing information on the subject with peers. Following the lack of the studies to incorporate abstinence and fidelity as one of many preventive methods of HIV/AIDS and other STD, it will be better for researchers to study the effect of these values on the reduction of the spread of HIV/AIDS.
Overall, studies are generalized to other settings in regard to the prevention of the infectivity of HIV and in regard to the population studied. By taking into account the reality of the non-African countries, we can apply the same study to population with the same characteristics of the experimental or control group. The government and private institutions can be involved in the process either by funding or technically providing their assistance. The studies have proven the efficacy of the preventive measures even though some population samples were not large enough. As mentioned earlier, it has taken place in the epicenter of the disease which is Africa, therefore reducing the prevalence in this geographical area will determinately reduce the prevalence in the world since the continent constitute more than 70% cases of the global prevalence (Mercy et. al, 2009). The gaps in these researches are that, they fail to tell us what the prevalence of HIV/AIDS is in preschoolers, teenagers, lesbians or drug users. It also fail to tell us if the higher rate of infant mortality and morbidity in Africa is a resultant of HIV/AIDS or other conditions given that HIV/AIDS cause a lot of damages there. The studies also have not told us why the prevalence of the infectivity/disease is still high in a region where U.S Senate is sponsoring the fight at $48 billion over a quinquennium started in July 2008, amount added to what the presidential plan raised (Bendavid and Bhattacharya, 2009). To reduce the impact of these gaps, researchers should inquired the impact of HIV/AIDS in infants and adolescents and the causes that led these young individuals to contract the disease. We should know the impacts of politics in Africa in the implementation of the fight against the disease. Since corruption is very rampant in Africa, studies should focus on factors that will contribute to reduce the negative impact of this malpractice that hinders the fight. Causes that let children to contract the disease should be investigated since there is a likelihood of some infants and preschoolers are being exploited by their elders for sex or other purposes. The studies should also consider the impact male have in the spread of the disease therefore there should be a study related to that. What do we know about health care in Africa? Is the severity of the infectivity due to lack of the health care? Or the patients are not able to afford it?
The success of HIV/AIDS depends upon the incorporation of all the issues that affect humankind and these are the living conditions, the economical status of the country in which patients live, the access to health care and its affordability. The politics behind the fight should be addressed and well managed for the program to succeed.
References
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