1 Running head: HIV in Young Americans

Investigation of HIV Occurrence in Young Americans Laurie Blake, Karen Gividen, Judy Kintner, Andrea Plati, Casey Thompson NURS 6030- 4 The Practice of Population-Based Care Walden University July 25, 2011

2 Investigation of HIV Occurrence in Young People Young people in the United States continue to be at risk for human immunosuppressive virus (HIV) infection, with the risk being more pronounced in African American youth ages 1324 (CDC, 2008). Education is instrumental in the fight to decrease the spread of HIV in youth. Public high schools in the United States provide education about HIV prevention. In this regard, each state must teach abstinence as part of its HIV education curriculum in order to meet federal funding requirements (Guttmacher Institute, 2011). However, each state mandates its own educational requirements, and so tailors the HIV education curriculum to meet the requirements set by the state board of education (Guttmacher Institute, 2011). Thus, HIV prevention education differs from state to state (Guttmacher Institute, 2011). In discussions with high school students, they revealed that their sources of information regarding HIV were primarily media and personal contacts (Rogers, Birenbaum & Marsh, 1993). While high school students also said they did receive HIV information in school, the students also reported that classes were often taught by teachers who were uncomfortable with the information and would not answer questions freely (Rogers, Birenbaum & Marsh, 1993). Also, the students noted that this repressive environment made them less likely to ask for further information, thereby minimizing the effectiveness of this important source of HIV information (Rogers, Birenbaum & Marsh, 1993). Understanding that HIV education is delivered through our schools, but recognizing that the presently provided HIV education may not meet the needs of our target population of American youth age 13-24, Team E will develop a program to reach this targeted population using all available educational means including social media resources.

3 Team E will review the etiology of the disease and how HIV is transmitted. As components of the program, the team will develop educational plans to influence a decrease in the spread of HIV, and increase dissemination of information about HIV testing. All information that the Team develops will take into account cultural norms of the target American youth population. Ultimately, Team Es program will lead to the development of an effective community outreach program which will target 13-24 year-old Americans to decrease the spread of HIV (CDC, 2008). Identification of the Etiology of the Problem Etiology There are 3 major routes of transmission of the HIV: 1 Sexual Transmission 2 Transmission via blood or blood products 3 Mother to Child Transmission The risk of transmission via tears, urine and saliva is considered to be negligible Pathophysiology 1 Entry to host cells (CD4+ lymphocytes, macrophages and monocytes) using gp120 with the help of chemokine co-receptors. 2 Life cycle of HIV (8 stages): 1. Viral binding 2. Entry and Uncoating 3. Reverse transcription 4. Integration into host chromosomal DNA 5. Synthesis of viral DNA 6. Translation and production of Viral proteins 7. Assembly of virus and budding from the host cell 8. Maturation 3 Then the virus is ready for infection Although AIDS was not officially recognized until 1981, researchers realized that cases in medical literature appeared to fit the AIDS symptoms as early as the 1960s (Osmond, 2003). Using a tissue sample from a 15-year-old black male from St. Louis, who was hospitalized in

4 1968 and subsequently died of Kaposi's sarcoma (KS), it was determined that the specimen was HIV-positive and noted to be the first confirmed case of HIV infection in the United States Osmond, 2003). Since then, approximately 40,059 young people in the United States have received a diagnosis of AIDS, and of those, 10,129 young people with AIDS have died (CDC, 2008). The youth account for about 4% of the estimated total of 944,306 AIDS diagnoses (CDC, 2008). According to the CDC, in 2004 an estimated 4,883 young people received a diagnosis of HIV infection or AIDS, representing approximately 13% of the total diagnoses for that year; however, HIV infection progressed to AIDS more slowly among the youth (CDC, 2008). Young men who have sex with men, especially those of minority races or ethnicities, are at a higher risk for HIV infection, representing 21% of the youth; whereas African Americans account for 55% (CDC, 2008). The division of male to female was 68% to 32%, respectively (CDC, 2008). One of the major risk factors of HIV in the youth is sexual intercourse. A study by the CDC determined that 47% of high school students are engaged in sexual activities (CDC, 2008). HIV prevention and education efforts must be a continual process and should include programs on abstinence or delaying sexual practices.

Identification of the Epidemiology of the Problem In identifying the risk factors related to acquiring HIV, transmission, occurrence and development of AIDS in adolescents are important aspects in fighting against this disease. Using epidemiological methods are able to convey key scientific questions by studying and comparing the effects of HIV in different human populations. Scientific findings gathered from these

5 epidemiological studies help provide insight in preventing the spread of HIV and improve the quality of life for those already infected. A major area of investigation from the National Institute of Allergy and Infectious Diseases includes studying the efficacy and effectiveness of therapies in clinical studies. The impact of antiretrovirals on HIV infection has prompted others to study the long-term clinical course of HIV infection in people using retrovirals. While there have been no signs of a decrease in the effectiveness of retroviral therapy, drug resistance remains a concern. Also, as people are continuing to live longer with HIV, many of the immunocompromised individuals, will naturally have a higher risk of developing other life threatening morbidities, such as heart disease, cancer, and at a younger age their HIV-negative peers. Epidemiological research includes: Identifying the proportion of the population affected by HIV and the rate at which new infections are occurring Describing the manifestations of the clinical and laboratory course of HIV infection, the change frequency with which various complications occur, and the impact of therapy on HIV-related survival and clinical outcomes Investigating the clinical course of HIV infection among people with other co-morbidities to better understand the natural and treated history of the disease in those with other chronic conditions

6 Evaluating the patterns of adherence to retrovirals in populations around the world, the predictors of disease progression, and the efficacy of retovirals in populations exposed to a variety of other concomitant infections and under nutritional and other health stressors Studying the biological, clinical, and epidemiological characteristics of people who are at high risk for HIV infection but do not become infected and those who are long-term nonprogressors. Identification of Existing Intervention Programs When dealing with any illness, prevention is always the key when attempting to decrease new transmissions. With HIV/AIDS transmissions affecting an estimated 1.1 million people (Healthy People 2020, 2011) in the U.S., every healthcare professional needs to help with prevention of this devastating illness. One effective preventive tool that is has shown to reduce the incidence of HIV/AIDS, along with other sexually transmitted illnesses, is condom distribution (Centers for Disease Control and Prevention [CDC], 2011). Condom distribution has been shown to save communities millions of dollars by preventing future HIV illnesses (CDC, 2011). If each community could educate its public and offer condoms, free of charge, this small initiative could have an impact globally. Another preventative measure that can help reduce the amount of patients affected by HIV/AIDS is providing a screening tool, such as a blood test, to assist patients in learning their HIV status. Approximately 21% of the people living with HIV/AIDS are unaware they have this disease (Long, Brandeau, & Owens, 2010 as cited by CDC). If the community health team can assist each patient in learning his/her HIV/AIDS status, the spread of this disease can be

7 diminished. Offering screening opportunities within each community offers a substantial health benefit and is cost effective in the battle against HIV/AIDS (Long, Brandeau, & Owens, 2010). By educating each patient regarding their disease status, the hope is that this newly diagnosed patient will be responsible in educating future sexual partners and use protection. Identification of Strategies that Address this Problem The health sector cannot overcome this epidemic alone, and while it is already too late for many youth, the ability to cut down on the possibility of others contracting HIV is worth fighting for. Only acting decisively to control HIV can ensure today's young people will have a future as adults. Youth development focuses on assets and strengths, not problems. The Search Institute identifies 40 measurable assets of young people, including support by parents or other adults, community service, involvement in extracurricular activity, academic goals, skill in making decisions, positive values, a positive view of one's own future, and social skills. In working to encourage young people to develop and rely on their own assets, the most promising programs focus on each young person's abilities while taking into consideration his/her individual family, social, cultural, and school environment. Such programs focus on developing young people's self-esteem, self-efficacy, and self-worth.

Other strategies would be to provide such services as tutoring, mentoring, recreational, job training, social skills, and community service. By reviewing these services we are able to meet the needs and build on the assets of the individual, and motivate young people and promote working toward achieving a successful future. Within the program educators or counselors assist young participants to build their social skills in order to recognize and include healthier aspects

8 like mutual respect between partners and their romantic relationships. Strategies also involve committed and knowledgeable adults, that foster trust amongst the adults and youth. Good programs will involve professional expertise, education and also someone without prejudice, and would also include family members if at all possible. An effective HIV prevention program provides links with existing youth development programs in order to meet all of the needs of participants and to refer them to services they need. Well-established, effective youth development programs like Girls Incorporated, YWCA, YMCA, 4-H, Boys and Girls Clubs, and Big Brothers Big Sisters may welcome partnerships with HIV prevention programs. Strategies also include communities working together to focus on the strengths and assets of young people rather than the "problem" behaviors they may demonstrate. Although few communities currently use youth development as a strategy to prevent negative health outcomes among young people, concerned adults, parents, professionals, community representatives, policy makers, and funding agencies should work with young people to develop young people's life options and ensure their healthy transition to productive adulthood.

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Development & Policy

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