Answer

Access to Care for Women with HIV and AIDS

Definition and description of the issue                                                                                           

HIV means human immunodeficiency virus. The virus attacks the immune system of the body thereby reducing the ability of the body to fight illness. The virus destroys the CD4 cells, a type of white blood cells that fight pathogens in the body (Centers for Disease Control and Prevention, 2012). HIV exist in many different strains, and infected individuals may carry different strains in their body. It gradually develops into a syndrome called AIDS at an advanced stage. The advent of the global HIV epidemic has seen women more vulnerable to the HIV infection than men. With 27% of new infections in the United States alone, women and adolescent girls posit a disproportionate number of new HIV infections, most of which are acquired through heterosexual transmissions. According to past research, women aged 15-24 years account for 60% of all new infections in 2013 (Prejean, Song, Hernandez, Ziebell, Green, Walker, Hall, 2011). This reflects over 380,000 newly infected women in 2013 only. HIV is the leading cause of death among women, yet, women with HIV have poor access to care and experience poor outcomes.

Background of the Issue

Human immunodeficiency virus (HIV) was first discovered in the 1980s in the USA and have since gained global attention. The HIV attacks the immune system of the body and destroys the CD4 cells that are responsible for defending the body against disease. This weakens the immune system of the body and, at an advanced stage, causes acquired immunodeficiency syndrome (AIDS) (Centers for Disease Control and Prevention, 2012). The virus is transmitted from one individual to another through direct body contact with an infected body including semen, blood, breast milk or infected mucosal membrane. The initial phase of the disease is symptomatized by the skin and upper respiratory tract infections coupled with the loss of weight by the patient. As the disease progresses, chronic diarrhea, fungal or bacterial infections, persistent fever, and tuberculosis may develop and as the patient’s immune system progressively deteriorates and the body loses its ability to fight other infections (Centers for Disease Control and Prevention, 2012).  This condition ultimately leads to acquired immunodeficiency syndrome (AIDS) and the patient becomes immunocompromised. This disease has neither cure nor vaccine, but effective antiretroviral therapy is significant in prolonging the life of infected individuals and reducing mortality.

The issue of access to care for women living with HIV/AIDS has been a growing concern for AIDS service organizations and other stakeholders (Prejean, Song, Hernandez, Ziebell, Green, Walker, Hall, 2011). Two major factors posit a serious concern for the needs of women living with HIV; the increased rate of contracting HIV among women, and the increased longevity of HIV-positive individuals whose lives appear relatively healthy (Prejean, Song, Hernandez, Ziebell, Green, Walker, Hall, 2011). Consequently, there is a need to formulate a long-term planning of support services that addresses the needs of women living with HIV/AIDS. Notably, HIV-positive women have specific concerns that relate to children, posing a definite need to support the infected women to access care without any barriers.

Stakeholders

To promote access to care for women living with HIV/AIDS, it calls for all inclusive and engagement of all stakeholders in a common course to eliminate the barriers that hinder the infected women from accessing care. The stakeholders include (Mugavero, Norton, Saag, 2011); the women living with HIV/AIDS, communities, policymakers, advocates, governments, funders, international agencies, religious and cultural leaders and regulatory bodies. Each of stakeholders has a critical role to play in promoting the access to care for the women living with AIDS (Mugavero, Norton, Saag, 2011).

Issue statement

Women, though already disproportionately affected by HIV and AIDS, continue to be the most vulnerable population to HIV infection. According to the 2005-06 ZDHS reports, the HIV prevalence is high among women aged 15-49 years with 21.4% compared to 14.5 per cent among males of the same age group (Centers for Disease Control and Prevention, 2012). The report further illustrates that early infection is more rampant among females compared to males. Despite this disproportionate figures, women living with AIDS have poor access to care owing to social barriers. Notably, women are more vulnerable to the structural issue that raises their risk of HIV infection such as gender-based violence, commercial sex work, transgenerational sex, employment disparities and educational (Centers for Disease Control and Prevention, 2012). To promote access to care for women living with HIV/AIDS, there is a critical need to eradicate all these structural issues.

Possible methods of addressing the issue

Addressing the issue of poor access to care for women living with AIDS involves working towards eradicating all the structural issues that act as social barriers to HIV-positive women in their quest for access to care (Aziz, Smith, 2011). Therefore, the possible method of addressing the issue is to adopt behavioral change methodology to address each of the barriers effectively.

Gender-based violence is deeply rooted in cultural and societal norms that uphold power differentials based on gender (Aziz, Smith, 2011). To address this issue, programs geared towards addressing behavioral and institutional change should be formulated. To achieve this, education on human rights and violence will be critical in creating awareness among the public on the importance of respect for women’s dignity and rights.

 Commercial sex work is a common practice among the women with lack of a sustainable source of income. This practice not only promotes the rate of transmission of HIV among the women but also lowers the dignity of the women in the face of the community leading to stereotypes towards women. Consequently, such women tend to isolate themselves and face family and social discrimination. To address this issue, the relevant health stakeholders should formulate policies that seek to outlaw commercial sex work so as to stop the practice (Aziz, Smith, 2011).

Transgenerational sex refers to sexual engagement between young people and adults of decade years older. This issue normally involves young girls and adult men more than otherwise. Consequently, the young girls are more vulnerable to HIV infection leading to the high prevalence of the disease among the young women population. To address this problem, girl child education on sexual matters is critical in creating awareness among the women population. The governments, as stakeholders, should formulate educational policies to foster sex education in the academic curriculum (Aziz, Smith, 2011).

Employment disparities are augmented by gender discrimination that sees few women gaining access to employment opportunities. The discrimination against HIV-positive women by employers has seen many infected women financially dependent leading to inability to access care whenever they need to. Policy makers, as stakeholders, should formulate policies that demand gender equality in every organization and that forbid discrimination in all its forms (Aziz, Smith, 2011).

Education of the community and the general public on the need to change the above structural issues is the single-most effective method to address the access to care for women living with HIV/AIDS. With public awareness of the subject and understanding of implications of the issue on the society, the social barriers to access to care for HIV-positive women will not find their way into the cultural and societal norms of any society (Aziz, Smith, 2011).

Goal

The goal of this document is to reduce the prevalence of HIV/AIDS among the women through improved access to care by eradicating all the structural issues that act as social barriers to HIV-positive women in seeking access to care.

Options for changes

To achieve this goal, this document present options for changes to adopt Option B+ that integrates the antiretroviral drug used for the prevention of mother to child transmission (PMTCT) and antiretroviral therapy (ART) (Coutsoudis, Goga, Desmond, Barron, Black, Coovadia, 2013). Initially, options A and B were used based on CD4 count, and they posit some limitations in which both cases heavily relied on CD4 testing that was not accessible in all areas of want. However, the option B+ provides a life-long treatment plan for HIV-positive pregnant women regardless of their CD4 counts (Coutsoudis, Goga, Desmond, Barron, Black, Coovadia, 2013). The B+ option present the best treatment option for promoting access to care for women with HIV as it does not depend heavily on CD4 testing to commence treatment. Consequently, the pregnant women with HIV, who cannot access the CD4 testing can easily access care of treatments through option B+. Some women from poor backgrounds can access ART at high levels even in poor settings with no access to CD4 testing (Coutsoudis, Goga, Desmond, Barron, Black, Coovadia, 2013). Notably, this option will promote access to care for HIV-positive pregnant women in hard-to-reach areas as the care can easily be provided at local health facilities that are ill-equipped with CD4 testing equipment.  

Risks and benefits of Option B+

Option B+ present several benefits. To begin with, it ensures all HIV-positive pregnant women receive triple antiretroviral for themselves and to prevent mother-to-child transmission regardless of their location and financial status. The option also helps in preventing future mother-to-child transmission and helps the patients to avoid the risk of starting and stopping the medication (Tenthani, Haas, Tweya, Jahn, van Oosterhout, Chimbwandira, Myer, 2014). Besides, option B+ is beneficial in the context of promoting early ART initiation and the simplicity of its programs and drug regimen. Moreover, treatment with option B+ can significantly reduce the risk of sexual transmission of HIV hence, help reduce the prevalence. Also, it improves the uptake of, and retention in ART programs through decentralization of ART services to all health facilities. Notably, the option can help reduce the incidences of tuberculosis when early treatment is started in women whose CD4 count is above 350. Besides, the option is crucial in reducing maternal mortality related to HIV. Finally, it helps to increase the chances of child survival and reduce stunting because ART makes breastfeeding among HIV-positive women safer hence the child will be normally breastfed without any fear of transmission thereby increasing the child’s chances of full development and survival (Tenthani, Haas, Tweya, Jahn, van Oosterhout, Chimbwandira, Myer, 2014).       However, the option B+ posit some risks to the users. To begin with, the option raises concerns about adherence challenges for pregnant and breastfeeding mothers who may fail to adhere to the medication process their by impair the functionality of the option and induce poor outcomes (Tenthani, Haas, Tweya, Jahn, van Oosterhout, Chimbwandira, Myer, 2014). The option also raises concerns about the safety of the fetuses and infants when exposed to ART.

Evaluation methodology

To evaluate the effectiveness of Option B+, the methodology used will be to examine the most critical criteria. This will involve examining the proportion of potential pregnant women in need of ART, are accessing the services within a given geographical boundary (Coutsoudis, Goga, Desmond, Barron, Black, Coovadia, 2013). The data collected from this survey will act as an indicator of the progress of the option in promoting access to care for women living with HIV. The data will be examined through “equity-lens” at the national level to assess whether the hardest-to-reach pregnant women are accessing ART and to determine whether the majority of pregnant women accessing ART hail from certain regions with better access to resources (Coutsoudis, Goga, Desmond, Barron, Black, Coovadia, 2013). If serious disparities are evident from the analysis of this data, it would be an indicator that change is needed. 

Recommendation

The fight against the prevalence of HIV/AIDS among the women can only be won through teamwork by all stakeholders. To improve the access to care for HIV-positive women, the policymakers should formulate policies that seek to dissolve all the structural issues that act as barriers to women in need of care and impose stiff penalties on individuals breaching such policies. The community should be educated on impacts of offensive cultures and societal norms that deny the women their rights and dignity and that hinder access to care for women living with HIV. The document further recommends that the option B+ be adopted by all states as the option posits several benefits among them being reducing the spread of the disease by preventing sexual transmission of HIV.

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