Efforts of the National Healthcare System in Tackling HIV

Efforts of the National Healthcare System in Tackling HIV

By Isaac Teoh Shi Yang

Prevalence of HIV and Related Case Study

The virus that causes acquired immunodeficiency syndrome (AIDS) is known as the human immunodeficiency virus (HIV), which kills CD4+ T cells vital to the body’s ability to fight infection. As a result of the compromised immune system, people living with HIV or AIDS are susceptible to a wide range of illnesses, in which the origin of HIV is thought to have spread to humans from nonhuman primates in Africa via cross-species transmission. In relation to that, multiple transmissions have happened, but the effects have been wildly disparate, some have resulted in huge global pandemics, while others appear to have caused little or no human spread.

Focusing on the region of Asia, specifically in Thailand, the first case of AIDS was recorded in 1984, promoting a total of 5990 cases to be reported in 1994 while 3959 of these cases were discovered in 1993. More than 600,000 persons in the country are thought to be HIV-positive but asymptomatic with the most common mode of HIV transmission is heterosexual intercourse. Although the Thai government first disputed that AIDS was a serious issue, it has since launched one of the world’s most vigorous and comprehensive HIV/AIDS control programmes as outlined in the breakdown below.

Between 1983 and 1987:

  • The government conducted rudimentary public education through select government STD clinics, with the goal of determining and documenting the extent to which HIV and AIDS had infiltrated society. Persons who were thought to be at high risk of infection were cautioned, and the Ministry of Health investigated reported AIDS cases. Serosurveillance was created among groups of people whose conduct put them at high risk of contracting HIV.

From 1987 to 1993:

  • An AIDS committee formed in 1985, led to the approval and implementation of an AIDS prevention and control plan that included HIV surveillance among a variety of target groups, AIDS education activities for the general public, and health personnel training to be carried out independently by various government units, mostly in the health sector.

The Centre for Prevention and Control of AIDS, which was established in October 1987, centralized operations, mandated universal testing of blood donations, and increased the overall government budget for AIDS from US$200,000 in 1988 to $45 million in 1993, spread across ministries other than those responsible for public health. Condom availability, medical treatment and counseling, secrecy and anti-discrimination regulations, as well as lessons gained and key achievements, are all discussed.

With that being said, similar approaches are being conducted globally, but the progress towards results in ending AIDS does not seem near. Despite the recent focus on HIV, there are still significant gaps in the provision of quality services for persons living with HIV and critical populations that are being left behind around the world.

  1. In terms of a global perspective, 4 out of 10 people living with HIV do not have access to treatment.
  2. Every day, almost 5000 people throughout the world become infected with HIV.
  3. In many parts of the world, stigma and discrimination, violence, and criminalization are rapidly excluding persons living with HIV and important populations from HIV prevention, testing, treatment, and care, as well as broader health and social services.
  4. The HIV response continues to face a financial shortage of $6 billion per year.

Tackling HIV at Its Core

The benefits of male circumcision, as well as the hoped-for promise of pre-exposure prophylaxis and microbicides, do not render behavioral measures useless. Behavioral techniques, on the other hand, need to become more sophisticated, integrated with biomedical breakthroughs, and scaled up. However, this is not a simple task. Sexual behaviors and the sharing of injection equipment, which are responsible for the majority of HIV infections globally, occur for a variety of reasons including but are not limited to reproduction, desire, peer pressure, pleasure, physical or psychological dependence, self-esteem, love, access to material goods, obligation, coercion and force, habit, gender roles, custom, and culture.

The range of sexual expression is considerably broader than most countries’ specified legal and moral systems recognize or sanction. Even though the stated legal and moral frameworks appear rather inflexible, most societies give chances for various sexual expression, frequently within the context of substance use, whether publicly or clandestinely. Because sexual behavior is rarely done in public, it is difficult to encourage protection when potential transmission occurs, and it is nearly impossible to verify what people say they have done or have not done. Drug usage to the point of drunkenness is not only permissible but essential to many countries’ economies, and efforts to regulate the distribution and sale of illegal substances, particularly injectable drugs, have mostly failed.

Knowledge, stigma reduction, access to services, delaying the commencement of first intercourse, reducing the number of partners, increasing condom sales or use, and reducing the sharing of infected injection equipment are all goals of the behavioral strategy. Therefore, a multilevel approach incorporating behavioral techniques is required where behavioral HIV prevention must be combined with biological and structural approaches, as well as HIV treatment for a more positive outcome.

Evidence of Success

In the United States, Canada, Europe, and Australia, the first effective examples of behavioral change that resulted in lower HIV incidence came from groups of males who had sex with men. Thailand and Uganda both took the HIV epidemic seriously early on and put in place measures to modify transmission patterns and lower HIV incidence rates. With the support of cross-sectoral cooperation, the reach of the church sector, and the inclusion of marginalized groups at high risk of HIV, Senegal was able to avoid an epidemic. Brazil, Côte d’Ivoire, Kenya, Malawi, Tanzania, and Zimbabwe, rural areas of Botswana, Burkina Faso, Namibia, and Swaziland, urban parts of Burundi, Haiti, and Rwanda have all observed reductions in HIV transmission linked to changes in sexual behavior. Harm reduction approaches that combine access to clean syringes and needles with education, outreach, and access to drug treatment have been successful in reducing HIV transmission acquired by sharing injection equipment around the world. In many regions and among many groups of people, heavy alcohol use and amphetamine use continue to be key drivers of HIV transmission.

Based on that, three implications can be deduced:

  1. To limit HIV transmission, a sufficiently significant number of people who are potentially at risk must first undergo fundamental behavioral change. For example, Uganda’s 70% reduction in HIV prevalence was associated with a 60% reduction in sex with non-primary partners, a 2-year delay in first intercourse, and increased condom use. Considerable HIV reductions in Uganda originated from public-health initiatives that sparked a societal process of risk avoidance evidenced by radical changes in sexual behaviors as reported by one review of the Uganda accomplishment concluded stating that the communication was clear and straightforward, and there was extensive participation from many areas of Ugandan society. Nevertheless, modest behavioral changes are beneficial, but changes in transmission necessitate a large number of people changing their behaviors significantly and maintaining these changes for an extended period of time.
  2. Basic and clear messages about a variety of risk reduction and health-seeking alternatives were delivered through a variety of communication platforms such as the delay of onset of first intercourse, reduction in the number of partners, condom use especially with non-primary partners, HIV testing, and treatment for sexually transmitted infections. One risk-reduction technique (such as abstinence or partner reduction) should not be prioritized over another (such as condom use), because people prefer variety, and a combination of tactics is vital.
  3. Local participation in message creation, production, and distribution was critical. In reality, leveraging the creativity and energy of individuals who are most affected by the epidemic to generate messages and tactics to encourage behavioral change is one of the most energizing activities in many HIV prevention programs and campaigns.

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