LITERATURE REVIEW

Liberty University

HIV AWARENESS AND PREVENTION METHODS

Darrian Montavias Lynch

HLTH 634-B01

September 11, 2020

e-Portfolio 3

Abstract

This literature review will outline the various issues within the transmission and risk of contracting Human Immunodeficiency Virus, also known as HIV, and other various sexually transmitted diseases. The importance of sexual health will be discussed, alongside various barriers that lead to the transmission or risk factors concerning HIV. Models of awareness and preventative methods will be hypothesized and analyzed to display the importance of someone’s overall sexual health. These awareness and preventative methods include training tools, education, as well as implementation of forming social groups, in order to normalize and progress the conversation of sexual health. The subject of mental health will also be discussed. This research will acknowledge the importance of and will directly link mental health services concerning sexual transmitted diseases and HIV.

Introduction

In a country filled with millions of people who are suffering from not having health care, we often forget certain areas of health that are very important. Poor sexual health is one of the leading causes of death in the United States. Sexual health is very important when we are discussing health concerns and issues across the nation. It is imperative that we talk about the risks and effects of having a sexual transmitted disease because so many lives could be saved. HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency System) are the most body damaging and deadly sexual health diseases in the world today. The number of HIV/AIDS diagnosis are increasing, and inquiring minds want to know “Why?” Is the use of contraceptive methods failing mankind? Is the lack of awareness and education on sexual health? These are all lingering questions that I have once asked myself. This research that I am conducting will include: what are the best contraception methods to prevent HIV/AIDS, what is PREP (Pre-Exposure Prophylaxis) and is it an effective prevention method to use, and is lack of educational awareness and poor mental health closely linked with HIV/AIDS? These are very important research questions that will help me understand the why the cases of HIV/AIDS diagnosis are increasingly rising.

I currently work in the field of HIV Education and Prevention and I am constantly baffled and concerned about the black community in regard to sexual health. I chose this topic because I want to effectively understand and explain to others, these same burning questions. As a gay black man, I am aware of the epidemic of HIV and AIDS. It has always been stigmatized within the African American community, especially as a gay black man. Someone will always think that if you are a gay male, in general, that you automatically carry the disease. That’s so not true. Although statistics and research has proven that African Americans that live with AIDS do not have the same life expectancy as other racial ethnic groups, there is a true reason to why these numbers are through the roof. The question is: Why are these numbers so high? There is a lack of educational awareness within the black community. Black people do not have many resources or plans that are implemented to help the community become knowledgeable and educated about HIV and STD’s. Most of the time, black people who are not educated increase their risks or chances to catch something or spread something to someone else. Also, the black community does not have much access to new information and testing options.

A lot of the stigma comes from the gay community. Black, but pretending “straight” men, who are on the down low or having sex with other men are afraid to come out of the closet or live in their truth. Our society has taught us that they are the reason for HIV and AID’s spreading, which is not always the case. Even though, unprotected sex is involved, that stigma alone will continue to control the decisions of those within the black community. What we should do is embrace everyone for their decisions and not badger them. This will eliminate those issues.

Evidence

With the biomedical industry progressing annually, there are still questions that need to be answered when it comes to certain epidemics. The HIV/AIDS epidemic is by far the most alarming. This epidemic has been on-going for decades. The purpose of my research is to bridge the gap between the epidemic and its causes versus effective prevention methods, whether it be through educational awareness or prescribed medicines and contraceptives. The research will also offer insight about the mental health state of those infected versus those uninfected and how it relates to prevention and post-life diagnosis.

There are increased reported cases of newly diagnosis HIV infections over the past 30 years. Theories say that education has a major influence in reduction of HIV-related risks and vulnerabilities of affected individuals and communities. Within the published research “Education and HIV/AIDS—30 Years On,” the authors reflect on progress over 30 years and how education for HIV Prevention has changed within the communities. “These include analyzing more carefully different forms of HIV-related education, their consequences and effects, and identifying the specific effectivity of education in general and HIV-related education in particular in achieving positive outcomes. The potential of education to enable new ways of seeing, understanding, and hoping is stressed, as is the need to support education processes and systems that “think” faster than the epidemic (Aggleton, Yankah, and Crewe 495).” I believe that we will see decreased numbers of new infections through education, including treatment education and prevention education. I will also be using a project example within Bangladesh that implemented teacher trainings on HIV/AIDS education that will showcase the outcomes and results.

Bringing awareness correlates with education in some aspect. I learned about the impact of the federal government towards HIV Prevention and government spending on HIV testing and awareness. Our federal system has the biggest impact on our prevention methods and testing services. Not only does Federal HIV Prevention independently correlate with increased HIV testing, but there is a fine line between federal spending and education methods towards newly diagnosed HIV infection cases. For example, MTCT (mother to child transmission) was the case variable, so the federal system used CDC (Centers for Disease Control) HIV prevention funding to validate the relation between being tested for HIV and awareness of methods to prevent MTCT. The research journal “Assessing the Impact of Federal HIV Prevention Spending on HIV Testing and Awareness” discusses this issue.

Before conducting my research on HIV, I was not aware about the impact of MTCT. Mother-To-Child HIV Transmission is one of the leading causes in new HIV infection cases. I always wondered myself, is there a way to conceive a child without the mother transmitting HIV to their newborn? The answer is absolutely yes! There are various of hormonal contraceptives and methods to take in order to prevent this from happening. Most of these contraceptives are drug interactions, but they are totally safe. “Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study” and “Drug-Drug Interactions, Effectiveness, and Safety of Hormonal Contraceptives in Women Living with HIV” will address these issues and offer insight about how it works, as well as the effectiveness of these preventative methods. I have acquired new information about patients who are diagnosed with HIV and how their mental health state affects transmission or prevention. Most of the patients are not equipped with new information so therefore they lack knowledge of control measures. Due to this, those patients who aren’t exposed to this information suffer from poor mental health once they are infected, causing death due to non-safety measures and lack of treatment.

Men that have sex with men (MSM) is the population that has the highest risks for HIV Infection in the world. One of every four gay men are infected with HIV/AIDS or another STD within their lifetime. Within the gay community, there are a few reasons to why numbers are increasing in new diagnosis of HIV/AIDS epidemic. These reasons include: transgender prostitution, MSM street based sex work, limited access to healthcare, limited Federal HIV prevention on testing and awareness, and poor mental health amongst MSM populations. Through federal regulation, healthcare initiatives, and the CDC, PrEP (Pre-Exposure Prophylaxis) was introduced to health reduce the risks of HIV infection in people who are high risk by up to 92%. Those who are sexually fluid or are dating someone who is HIV Positive are encouraged to see their health care provider and get prescribed to PrEP. Being that the LGBT Community carries the greater risk, they are strongly encouraged to take this prevention method to decrease the virus within the infections within the community. This is the basis of my research and the remainder articles within my bibliography will display that.

So, what are we truly trying to accomplish? We want and need to know what are the best contraception methods or preventative methods to help prevent the spread of HIV/AIDS in women, gay men, and significantly black gay men? Women and MSM’s are the most affected in U.S., while Black or African American decent are mostly affected worldwide.

There are many trials of antiretroviral (ARV) medication as chemoprophylaxis (treatment) against HIV, most of which require Antiretroviral therapy for prevention (ART). The most common drug that is used for prevention of HIV is Pre-exposure prophylaxis, also known as PrEP. It has been approved by the Federal Drug Administration (FDA) to reduce the risk of HIV transmission, significantly for men who have sex with men. As mentioned previously, MSM’s count as the most affected population for HIV infections in the United States. The motivators to use PrEP include factors such as sex work/prostitution, high sex risks, irregular patterns or behaviors through sex engagement, or partners that are infected. Most of the participants felt that it was beneficial to self and the community. Others felt they were at high risk with men that were infected with HIV so they wanted to take it for safety precautions.

The usage is one pill a day of tenofovir/emtricitabine disoproxil fumurate (TDF-FTC). Now we wonder, if this pill helps prevent transmission and acquisition, how come people aren’t taking it or hip to this? BARRIERS. There are many barriers to PrEP use. “Across existing studies of this approach to prevention, adherence appears to be a major factor contributing to the efficacy of PrEP for HIV; two studies in African women found no benefit from PrEP in the setting of poor adherence (Wade Taylor, S., et al. 871).” In simpler terms, participants do not stay consistent with the drug. This is where Antiretroviral therapy for prevention comes in. According to Wade Taylor, S., et al., the FDA indication for PrEP for MSM was highly influenced by the results of the iPrEx (pre-exposure prophylaxis initiative) Study, a global, multi-site randomized control efficacy trial, that showed over a three-year period that MSM at high risk for HIV infection assigned to take oral tenofovir-emtricitabine as PrEP reduced their risk of acquiring HIV by 44 % compared with those randomized to the placebo. Most of the participants for the study were gay and most of their barriers included: side effects (e.g., nausea, diarrhea, anxiety, insomnia), mood, substance use, economic/occupation concerns, and familial concerns. Others were concerned with their down-low status with their provider, needing insight on the drug, and billing issues.

When there is a lack of educational awareness, it is very difficult to help individuals prevent HIV/STD’s. Most people do not realize that sexual health is important, as their state of overall health is concerned. Mental health concerns and educational concerns were very prominent within the barriers aspect.

“Gay and bisexual men and other men who have sex with men (MSM) experience significant mental health disparities, including depression, distress, trauma and substance use compared with heterosexual men. For example, compared with heterosexual men, rates of depression and distress are estimated to be 17% higher among MSM, and rates of post-traumatic stress disorder (PTSD) and substance use are twice or greater among gay and bisexual men and other MSM compared with heterosexual men. The relative high frequency of mental health problems among MSM seems to be even higher among MSM living with HIV/AIDS. Accordingly, mental health problems are consequences of distressing environments, including stigma, prejudice and discrimination, which result in negative psychological outcomes including expectations of rejection, hiding and concealing, internalized homophobia or homo-negativity and problematic coping strategies (Batchelder et. al, 2017).”

We should acknowledge the fact that having poor mental health can definitely affect individuals and it can lead to making poor decisions. Most of the reported cases that are found are due to having poor mental health. It is imperative that individuals in society promote awareness and prevention to help overcome such adversity.

Conclusion

The sole purpose of this research is to configure a method in order to stop the rise or increase of HIV and other sexually transmitted diseases. There are many ways that we could reduce the risk of transmission of HIV but there has to be an implemented plan in order to do so. The research question that I proposed was “Is the lack of education awareness or poor mental health closely linked with HIV/AIDS?” This is a very interesting question to pose.

I believe that lack of education is one of the main reasons that individuals are exposed to HIV/AIDS. There is not enough community engagement nor prevention tools to provide such information to those who are not equipped with knowledge about HIV/AIDS. Being socially unaware about epidemics can result in poor decision making in regard to sexual health. Mental health is one of the biggest causes of poor decision making. Those who are suffering from any kind of mental illnesses or disturbances are sometimes restrained from making effective decisions. The population that I will study would be men and women ages 16-55. This specific population group will give me an understanding about their specific thoughts or concerns regarding their sexual health. I will recruit my study sample by engaging with clients within medical and health settings or clinics. I will also recruit by asking random adults to participate that are within that specific population.

I will use survey’s and focus groups as my means of methodology. These survey’s and focus groups will be cross-sectional, in which I will study a number of individuals of different ages who have the same trait or characteristics of interest at a single time. It will also be cross-sequential, in which I will test individuals more than once over a specified period of time. The data that will be gathered includes: What ways do you feel are most effective to preventing HIV/AIDS epidemic, what ways do you feel are most effective to preventing HIV/AIDS epidemic in LGBTQ Community, which barriers do you feel affects prevention services the most (language, communication measures, marketing, educational, mental services), and have you personally heard about PreP or any other contraceptive methods?

By conducting my research through the cross-sectional and cross-sequential methodology, I will be able to see what the participants pre-thoughts are before being examined and offered services and information, as well as post thoughts after being offered services or information. Strengths of this research study would be getting an understanding of client’s knowledge about their sexual health and weaknesses would include the level of engagement or effective understanding of the content. Within my findings from peer reviewed articles, clients may often disengage from topics when it is relatable to their sexual health. Some clients find it hard to have a conversation. Now, the most important part is finding a way to open the conversation and keep clients engaged and involved. My intervention is called “Healthy Initiatives.” The primary target audience for Healthy Initiatives program would be for minorities, typically aging between ages 13-55. African American and Latino men and women, specifically for black and Latino gay men, transgenders men and women, and black women are at risk for infectious diseases, including HIV being the most typical. The ultimate goal and mission is to have clients obtain and acquire self-reliance to care for self once they are provided services, knowledge/education, and information about how to take initiative for one’s own health. These strategies will fully equip clients to successfully care for self.

In conclusion, it is very important that we take a stand and create social change for humanity and mankind. We should take accountability for our sexual health and also create awareness for preventative measures that are offered to us. These contraceptive measures mainly include condoms, birth control, and PrEP. They are the most commonly used methods to prevent any type of negative or unwanted sexual health outcomes. It is important for us to educate one another and also become educated on things that are unknown to us.

For future studies, there will be case studies involved. These studies are to prepare for future vaccines and medicine. Other studies will include therapy that could possibly lead to more effective preventative methods. More research will be conducted to help aid those who experience significant barriers to overcome poor sexual health.

Bibliography

Aggleton, Peter, Ekua Yankah, and Mary Crewe. "Education and HIV/AIDS--30 Years

on." AIDS Education and Prevention, vol. 23, no. 6, 2011, pp. 495-507, Criminal Justice Database; Education Database; Political Science Database; ProQuest Central; Sociology Database, http://ncat.idm.oclc.org/login?url=https://search-proquest-com.ncat.idm.oclc.org/docview/912749997?accountid=12711 , doi:http://dx.doi.org.ncat.idm.oclc.org/101521aeap2011236495.

Batchelder, Abigail W., et al. "Mental Health in 2020 for Men Who have Sex with Men in the

United States." Sexual Health (Online), vol. 14, no. 1, 2017, pp. 59-71, ProQuest Central, http://ncat.idm.oclc.org/login?url=https://search-proquest-com.ncat.idm.oclc.org/docview/1868523235?accountid=12711 , doi:http://dx.doi.org.ncat.idm.oclc.org/10.1071/SH16083.

Coulter, Id, et al. "Associations of Self-Reported Oral Health with Physical and Mental Health in a Nationally Representative Sample of HIV Persons Receiving Medical Care." Quality of Life Research, vol. 11, no. 1, 2002, pp. 57-70, ProQuest Central, http://ncat.idm.oclc.org/login?url=https://search-proquest-com.ncat.idm.oclc.org/docview/883843374?accountid=12711 , doi:http://dx.doi.org.ncat.idm.oclc.org/10.1023/A:1014443418737

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Healthline. (2019). The History of HIV. [online] Available at:

https://www.healthline.com/health/hiv-aids/history#prep [Accessed 12 Oct. 2019].

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Lorenz, Karl A., et al. "Changes in Symptoms and Health-Related Quality of Life in a Nationally Representative Sample of Adults in Treatment for HIV." Quality of Life Research, vol. 15, no. 6, 2006, pp. 951-8, ProQuest Central, http://ncat.idm.oclc.org/login?url=https://search-proquest-com.ncat.idm.oclc.org/docview/883809849?accountid=12711 , doi: http://dx.doi.org.ncat.idm.oclc.org/10.1007/s11136-005-6010-x

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Scarsi, Kimberly K., et al. "Drug-Drug Interactions, Effectiveness, and Safety of Hormonal

Contraceptives in Women Living with HIV." Drug Safety, vol. 39, no. 11, 2016, pp. 1053-1072, ProQuest Central, http://ncat.idm.oclc.org/login?url=https://search-proquest-com.ncat.idm.oclc.org/docview/1861025723?accountid=12711 , doi:http://dx.doi.org.ncat.idm.oclc.org/10.1007/s40264-016-0452-7

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Prophylaxis Providers among Men Who have Sex with Men and Men Who Engage in Street-Based Sex Work in the US." PLoS One, vol. 9, no. 11, 2014, ProQuest Central, http://ncat.idm.oclc.org/login?url=https://search-proquest-com.ncat.idm.oclc.org/docview/1622597781?accountid=12711 , doi:http://dx.doi.org.ncat.idm.oclc.org/10.1371/journal.pone.0112425

Wade Taylor, S., et al. "Optimizing Content for Pre-Exposure Prophylaxis (PrEP) Counseling for MenWho have Sex with Men: Perspectives of PrEP Users and High-Risk PrEP Naïve Men." AIDS and Behavior, vol. 18, no. 5, 2014, pp. 871-9, Criminal Justice Database; ProQuest Central; Sociology Database, http://ncat.idm.oclc.org/login?url=https://search-proquest-com.ncat.idm.oclc.org/docview/1515233197?accountid=12711 , doi:http://dx.doi.org.ncat.idm.oclc.org/10.1007/s10461-013-0617-7