HSSM48 - Epidemiology for Public Health -University of Sunderland

HIV/AIDS - WHY TO INVEST AND PREVENT IN UK

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Case Study Report

On
HIV/AIDS - WHY TO INVEST AND PREVENT

(An Evidenced Base Case Study Report on HIV/AIDS to Invest and

Prevent in UK)

Submitted
To
(University of Sunderland)
(Faculty)

By

(Student ID.........)

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Table of Contents
1. INTRODUCTION AND BACKGROUND ............................................................................................................ 6
2. THE ISSUES OR PROBLEMS OF HIV/AIDS IN UK ............................................................................................ 6
2.1 HIV RELATED OPPORTUNISTIC INFECTIONS ................................................................................................ 7
3. CASE STUDY ................................................................................................................................................. 9
3.1 SUMMARY OF REFERENCED DOMAIN CASE ............................................................................................. 10
3.2 LIVING WITH HIV BOTH DIAGNOSED AND UNDIAGNOSED (ESTIMATED) IN UK 2017 ............................... 11
3.3 MORTALITY RATE OF ONE YEAR AMONG NEWLY DIAGNOSED WITH HIV CD4 ......................................... 11
3.4 THE TOTAL HIV INFECTS LIVING IN UK ...................................................................................................... 12
3.5 PEOPLE DIAGNOSED LATELY IN UK YEAR 2008 TO 2017 ........................................................................... 13
3.6 THE EFFECTS OF HIV ON BODY ................................................................................................................. 13
4. WHY SHOULD HIV CONSIDERED A PRIORITY HEALTH ISSUE ....................................................................... 15
5. FINDINGS ................................................................................................................................................... 15
6. DISCUSSION ON KEY FINDINGS .................................................................................................................. 16
7. CONCLUSION ............................................................................................................................................. 16
8. RECOMMENDATION .................................................................................................................................. 16
9. REFERENCE LIST ......................................................................................................................................... 17
10. APPENDIXES ............................................................................................................................................. 19

List of Figures
Figure 1-AIDS Case Definition ................................................................................................................. 7
Figure 2- Occurrence of Opportunistic Infection .................................................................................... 8
Figure 3-Mutual exclusive transmission Risk .......................................................................................... 9
Figure 4-Continnuum of HIV care UK 2017 .............................................. Error! Bookmark not defined.
Figure 5-Estimated People Living with HIV, UK 2017 ........................................................................... 11
Figure 6 - Yearly Mortality Rate Among Adults newly Diagnosed with CD4 ........................................ 11
Figure 7- Total Number of People Living with HIV-UK-2017(Estimate) ................................................ 12
Figure 8-Adjusted number Diagnosed late by risk group 2006 - 2017 ................................................. 13
Figure 9 - The effects of HIV in the Human Body .................................................................................. 13

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List of Abbreviations
1) HIV – Human Immunodeficiency Virus
2) AIDS – Acquired Immunodeficiency Syndrome
3) CD4 Count – is a blood test for checking the amount of CD4 Cells
4) ART – Antiretroviral Therapy
5) SHS – Sexual Health Services
6) MSN – Men who Sex HAVE Sex with Men
7) SRH – Sexual and Reproductive Health
8) GUM – Genito - Urinary Medicine
9) ART- Antiretroviral Treatment
10) (PrEP) – Pre-exposure prophylaxis
11) Ols – Opportunistic Infections
12) WBC – White Blood Cell
13) Crl – Credible Interval
14) STDs – Sexually Transmitted Diseases
15) MPES - Bayesian multi-parameter evidence synthesis

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Abstract

The HIV/AIDS is a global issue and it has to give importance for prevention and prioritized
actions to prevent HIV infection. The continuous dynamic strategic actions required for to
control the spread of HIV, control of opportunistic diseases and mutually exclusive
transmission risk. The promotion programs increases the awareness and decreases the HIV
infects, besides that early detection is also reduces it due to control of HIV infected one. This
case study covered demographic classifications and detailed analysis of different groups. The
findings are:-

1. HIV/AIDS is a global issue and every country has to stick with UNAIDS programs to
fulfil the target
2. Health promotion programs required for building awareness about breast cancer and
community building for early recognition and prevention and precaution.
3. HIV/AIDS prevention and precaution programs should be executed for early detection
and diagnose of HIV
4. There is no remedy for curing the HIV/AIDS and only precautions are there to
prevent it.
5. Those who living with HIV affects other opportunistic diseases and also many
transmission risks exists
6. Precaution and avoidance of HIV is the remedy for HIV
7. The HIV infected not reporting transmission risk of HIV/AIDS to surveillance system
8. The HIV affected individuals suffer immunity deficiency and they are victims of
primary infections, early stage infections, intermediate and advanced stage diseases
9. There are many mutually exclusive HIV transmission risk categories
10. There are many diagnosed and undiagnosed HIV patients in UK
11. The estimated HIV patients in UK 2017 year is, 101,600 HIV affected and out of that
93,800 diagnosed and 79,000 not diagnosed
12. The HIV affects all main parts of the body and it affect mentally, physically and
emotionally

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1. Introduction and Background

This descriptive evidence based case study focused the epidemiology of HIV/AIDS in UK
and analysing the aetiology of it. In addition evaluate and examine with evidence to address
why HIV/AIDS should to be considered with a national priority of a public health issue. In
addition, this report analysing the issue and evidencing for the investment need of this
jeopardized problem for its prevention and promotion by department of health in UK.

The seriousness of human immunodeficiency virus (HIV) is that, since the recognition of HIV
in 1980’s, there is no remedy find out for this human immune system targeting virus. It
weakens human defence system and prevents to act against infection and some sort of
cancer. The HIV both destroys and impairs the functions of the immune cells, besides that
the infected person reach in immune deficient and the immune function measured by CD4
cell count, in addition the immunodeficiency leads to susceptibility to a broad range of
infections like cancers and other diseases that human fight with healthy immune system.
When HIV become in a most advanced stage is called acquired immunodeficiency syndrome
(AIDS), the time period of this is 2 to 15 years depending on individuals, more over AIDS
caused to develop cancer, infection and serious clinical manifestations.

The overall responsibility of health system is not only developing strategies but also
practically building community aiming health promotion and prevention of health issues by
allocating resources for it. This report provides evidences for new policies on HIV/AIDS and
demanding for investment in this serious issue for its promotion and prevention.

2. The Issues or Problems of HIV/AIDS in UK

Refers to the report (Nash S, 2018), the fearful issue is , there are an estimated 101,600 HIV
infected in 2017, out of that 98% were receiving treatment and 97% were virally suppressed
and 97% were virally suppressed, besides that 87% of HIV holders have an undetectable
viral load and unable to pass on the infection.

Refers to US Department of Human Health and Service defined it as, “a disease of the
immune system due to infection with HIV. HIV destroys the CD4 T lymphocytes (CD4 cells) of
the immune system, leaving the body vulnerable to life-threatening infections and cancers.

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Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of HIV infection. To
be diagnosed with AIDS, a person with HIV must have an AIDS-defining condition or have a
CD4 count that less than 200 cells/mm3 (regardless of whether the person has an AIDS-
defining condition.” (AIDS Info, 2019).

The issue remains until the last HIV demolished, therefore the issue is critical and remedies
to be find out, otherwise prevention and precaution has to be carried out until a permanent
solution.

Figure 1-AIDS Case Definition

Source: (AIDS Info, 2019)

2.1 HIV Related Opportunistic Infections

The opportunistic infections are a crucial issue with HIV, one who living with HIV has a
diluted immune system and it make the body more vulnerable to a host of illness and over
period the HIV attacks CD4 cells in the body. There are opportunistic infections that affect
when the period of time passes HIV destroys immune system (Figure-2). There are primary
infections that reflect between 0-10 week time and 10 weeks to 5 years is the early stage
and there HIV attacks CD4 cells and it follows intermediate and advanced stages 5 to 10
years and 10 to 13 years respectively and many diseases will attack the body and the CD4
blood count diminished as shown in (Figure-2) below.

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Figure 2- Occurrence of Opportunistic Infection

Source- (Nash S, 2018)

The transmission risk of HIV/AIDS normally reported less to the national surveillance system.
So it has to be addressed and new methods to be developed for improving it. The scope of
mutually transmission risk describes in Figure-3

The HIV get one to another by contact with specific bodily fluids of other one that living the
virus like blood semen and breast milk, besides that HIV transmitted when make
unprotected sex or through shared injection tools or from mother to baby during
pregnancy, during birth and breast feeding and contaminated blood transitions. The use of
condoms during intercourse or taking PrEP always will protect you from HIV infection from
sex. The expected or new mother also if taking HIV treatment and if avoid shared injection
tools that using for drugs will also protect one from HIV. The available and effective
treatment reduces the viral load of one those living with HIV and this cannot reflect in a
blood test that means they can’t pass HIV. The behaviour and the conditions that put great
risk of contact HIV are:-

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a) Both unprotected anal or vaginal sex

b) Sex with STD infected one
c) Sharing injecting equipments
d) Receiving unsafe medical procedures like unsafe injection, blood receiving, tissue
transplantation and anything involved unsterile cutting and piercing.
e) Incidents like accidental injuries when dealing with health workers.

Figure 3-Mutual exclusive transmission Risk

Source- (Nash S, 2018)

3. Case Study
The referenced Case Study Domain – Progress towards ending the HIV epidemic in the
United Kingdom- 2018 December by Public Health England (Nash S, 2018), has also
connected with background of UNAIDS 90:90:90 targets.( “UNAIDS” 90:90:90 – A- UN -
fast track project target to 2020 , 90% of the people living with HIV know their status, of
whom 90% are on treatment: of whom 90% are virally suppressed (90:90:90), such as fewer
than 500, 000 new HIV infection yearly – a 75% reduction from 2010)

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3.1 Summary of referenced domain Case

The report suggests achieving maximum impact on HIV, that a combination HIV prevention.
such as adopt a complementary evidence based behavioural , biomedical and structural
strategies those in the context of well researched and easy to understand the local
epidemiology and there some key elements of the combination HIV prevention consists of
condom provision , pre exposure prophylaxis (PrEP) and expanded HIV testing also
diagnosis.

The combination HIV prevention is a commissioning framework and it also serve as a

strategy for individual to HIV prevention, such as every individual combine various tools or
appropriate or in sequence based on their situation or preference and risk level. Individuals
can approach their best suits ones needs as one’s life circumstances change. The
combination of HIV prevention includes that the primary prevention such as focused on HIV
negatives and prevention of onward transmission and it includes:-

a. It is tailored to for national and local needs and contexts

b. It is based on community centred and its approach to social determinants of health
c. It is flexible and adaptive to changing patterns, besides that it quickly deploy
innovation

Figure 4- Continuum of HIV Care, UK: 2017

Source- (Nash S, 2018)

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3.2 Living with HIV both diagnosed and undiagnosed (estimated) in UK

2017
Another vital factor is those who living with HIV both diagnosed and undiagnosed, the
number of HIV infected estimated in UK 2017 is 101,600 out of that diagnosed estimation is
93,800 and undiagnosed is 7,800. The demographic is gay and bisexual men, black African
men, black African women, non-black African men, non black African women and people
who inject drugs. (Figure-5)

Figure 5-Estimated People Living with HIV, UK 2017

Source- (Nash S, 2018)

3.3 Mortality rate of one year among newly diagnosed with HIV CD4
In the year 2017, there were 428 people died with HIV infection and the half of deaths
among people above 50 years of age and over. There approximately 58% of deaths are
connected with attributable AIDS definable diseases and there is 248 deaths that were
preventable deaths. (Fig-6)

Figure 6 - Yearly Mortality Rate Among Adults newly Diagnosed with CD4
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Source- (Nash S, 2018)

3.4 The total HIV Infects living in UK

Based on the MPES model estimate tool reveals that, the fractions between people living
with HIV and HIV undiagnosed fractions changes had been used for better estimates for
providing better PWID to the low risk groups. An estimate of 101, 600 people HIV infections
in UK using these estimates and the overall prevalence of HIV in England was 1.7 per 1000;
among people all ages and 2.2 per 1000, and aged 15-74 years. (Figure-7)

Figure 7- Total Number of People Living with HIV-UK-2017(Estimate)

Source- (Nash S, 2018)

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3.5 People Diagnosed lately in UK Year 2008 to 2017

The report (Nash S, 2018) argues, the problems exists in the late diagnosis is the vital predictor
of the morbidity, besides that premature mortality those with people suffering with HIV
infection also individual diagnosed very late are possible to have been living with
undiagnosed HIV infection for about 3 to 5 years and been at danger of passing on HIV
infection to partners if not use condoms for surveillance aims and late HIV diagnostics is
defined as have a CD4 cell count. Figure-8

Figure 8-Adjusted number Diagnosed late by risk group 2006 - 2017

Source- (Nash S, 2018)

3.6 The effects of HIV on Body

The HIV slowly weakens the human body’s natural defence system and the signs and
symptoms happen after the virus enters in the human body. The impact of HIV that makes
in the human body explained in the Figure. 9.

Figure 9 - the effects of HIV in the Human Body

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4. Why should HIV considered a priority Health Issue

There is no single prevention method nor does approach stop the HIV/AIDS epidemic on its
own and some methods proved it can reduce the risk and can protect against HIV infection
such as using condoms, antiretroviral medicines, and voluntary male medical circumcision,
behaviour change interventions to reduce the number of sex partners, use of clean needles
helps to reduce the HIV patients. Based on explanations throughout this study reveal that,
department of health should take decisions to change the medical policies by participating
with medical professionals due to the dangerous nature of the HIV/AIDS.

5. Findings
The detailed study of the selected case domain (Nash S, 2018) and required random
evidence reported here to address why to prioritize HIV/AIDS a national health issue,
besides that to answer health department why to invest in it for future HIV/AIDS prevention
and precaution. The findings are:-

1. There is no remedy for curing the HIV/AIDS and only precautions are there to
prevent it.
2. Those who living with HIV affects other opportunistic diseases
3. There are many transmission risks exists
4. Precaution and avoidance of HIV is the remedy for HIV
5. The HIV infected not reporting transmission risk of HIV/AIDS to surveillance system
6. The HIV affected individuals suffer immunity deficiency and they are victims of
primary infections, early stage infections, intermediate and advanced stage diseases
7. There are many mutually exclusive HIV transmission risk categories
8. There are many diagnosed and undiagnosed HIV patients in UK
9. The estimated HIV patients in UK 2017 year is, 101,600 HIV affected and out of that
93,800 diagnosed and 79,000 not diagnosed
10. The HIV affects all main parts of the body and it affect mentally, physically and
emotionally

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6. Discussion on Key Findings

The people in UK have a long life time and the women have a higher life expectancy of 80.5
and men have 75.8 years, likewise by in 2030 about 1 in 5 individual UK will be 65 year age
or more. But the statistics of HIV shows improvements in prevention and precaution
shouldered with UNAIDS strategies. Even though to move a far ahead without stop to
prevention of HIV, because there is no permanent remedy until now and only precaution is
the remedy at ongoing.

The HIV affected have viral load in body and there is more chances to defeated by
opportunistic diseases, besides that there are transmission risks exists there and it is a very
critical and prevention it with suitable remedies are unavoidable. When precaution and
prevention and avoidance are the choices, the responsibility will increase for diminishing the
HIV infected people.

The HIV is the viral load that brings many other infections, such as primary category diseases
early stage infections, intermediate and advanced stage diseases. The prevention of these
from primary stage required more care, besides that the mutually exclusive HIV
transmission categories are also big obligation for prevention strategies. The diagnosed and
undiagnosed HIV patients in UK required care and effort for to bring for diagnose. The HIV
infected all parts of the body and it affect mentally, physically and emotionally also,
therefore dealing with HIV prevention, precaution required resource.

7. Conclusion
The HIV prevention and precaution process is a continuous one and it not ends until a
remedy find out, it continues to demolish the last HIV and cure last HIV infected. Therefore
self protection, community building, promotion programs, campaigns by individually,
government basis or organisational basis are encouraged, besides that it is a global issue
and responsible every individual globally.

8. Recommendation
The HIV education and awareness should be repeatedly performed, it is a continuous
process otherwise people not alert for it, more over it has to repeatedly messaged through

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media or social networks with different discourses and confirm it that village to
metropolitan cities are covered including the whole category of demography.

9. Reference List
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10. Appendixes

Appendix-1- The ways of HIV affected one

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