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The following essay will define global health, identity, and examine the global health challenge of Human Immunodeficiency Virus (HIV) and Acquire Immunodeficiency Syndrome in South African (S/A) and the impact globally. Furthermore, it will analyse relevant health data of total death and the Disability-Adjusted life years (DALYs) due to HIV and AIDS globally, S/A and the United Kingdom (UK). Moreover, the present outstanding global policies and initiatives established to address HIV and AIDS within the two countries will be discussed and evaluated. The collaborative public health services, organisations and charities that worked in partnership to address HIV and AIDS, health inequalities, the determinant of health globally S/A and UK will be identified, discussed, and analysed. Finally, the role of the future nurse, health promotion models applied to tackle this challenge will be critically analysed and discussed using an evidence-based guideline and the overall conclusion.
Global health is a study that prioritises peoples health, to promotes health equity, minimise the spread of diseases and illness and ensure that individual has access to resources that will improve health and well-being (Crips, 2016). The importance of global health to the future nurse is to acquire effective knowledge that is required to deliver a culturally competent standard care and promote individual health and well-being in a globalised world.
South African is a developing country located in Sub-Sahara African with an estimated population of 56,668.602. HIV and AIDS is the leading cause of death in South Africa. It is a virus that weakens the white blood cells of the immune system to become vulnerable to sexually infected diseases (STI) and when proper medical treatment is not provided it will be developed to AIDS. ( HIV.Org, 2020). According to the Institute of Health Metric and Evaluation (2018), there is an estimation of total DALYs of 2.18% and death of 1.71% caused by HIV and AIDS across all aged group globally. DALYs is the total number of years an individual lived with disability from a specific disease and the total number of years lost in death in relates to the diseases (Hagell & Cheung, 2019).
In South African total DALYS of 30.6% and death of 28.46% was due to HIV and AIDS in the overall population. However, young adult between age 15 to 49 years is at most risk of HIV transmission because of a total DALYs of 46. 34% and death of 58.95%. Whilst total DALYs of 50.26% and death of 67.19% was recorded on females in the same age group (WHO, 2020; IHME, 2018). These statistics indicated that South Africa suffered from the global burden of diseases and the trend on the prevalence of HIV and AIDS remains high because of health inequalities, unequal right and intimate partner violence against women (Frade & De Wet-Billings, 2019). However, the UK is a developed country with an estimated population of 66.7 million (ONS, 2019). In 2017, there was a total DALYs of 0.1% and death of 0.043% of male and female due to HIV and AIDS. Though, the ages of 15 to 49 were total DALYs of 0.23% and 0.56% death (IHME,2018). According to Public Health England (2018), an estimation of 92% of 102,000 people living with HIV in the UK in 2017 was diagnosed, 98% of people diagnosed received treatment while 97% of those treated was virally suppressed. This reveals that the UK has attained above the UNAIDS 90:90:90 targets.
HIV and AIDS Policies are a legal framework established to improve the success of treatment and minimise HIV and STI transmission (CDC, 2020). Prevention of Mother to Child Transmission (PMTCT) is a global policy Fast-Track- Target 90-90-90 by United Nation for AIDS (UNAIDS) to minimise infection and eradicate HIV and AIDS by 2030. This meas=ns that if the target is achieved HIV and AIDS will no longer be a global threat. PMTCT policy aims were to encourage HIV infected mothers to use contraceptive pills and prevent unwanted pregnancy. Also, to provide immediate ART to pregnant and breastfeeding mothers that will prevent HIV transmission during childbearing and support them throughout the antenatal and postnatal period (WHO, 2010). The policy was target mostly at Sub-Sahara African countries because of the high mortality rate of the women and infants in a result of HIV transmission. In 2014, 90% of HIV testing was delivered to women in the southern and eastern part of Sub- Sahara Africa. Whilst above 80% of them living in the 21 global plan countries receives ART from the first antenatal check. This was to improve the health of an estimated 1.2 million babies that are vulnerable to HIV infection. Moreover, 51% of babies received HIV testing at 2 months old (WHO, 2015).
Nevertheless, PMTCT encountered several challenges during its achievement as many women withdraw from the ART after childbirth. Thus was because of the distance between health facilities and insufficient finance. Another reason was out of stigma and fear of disclosing sexual status to their partners (Knettel et al., 2018). Alhough, Van Lettow et al (2014), suggested that Women that was referred from antenatal check to ART clinics programmes with follow up are more likely to have greater postnatal care to compare to those that enrolled on ART from the first antenatal check. Therefore, utilising a standard approach to monitor and report patients continuation in treatment is very effective to identify unauthorised move of a patient within the health care settings (Jones et al., 2019). Hence, scarcity of HIV test kits, Antiretroviral drugs (ARV), the death of women in care and poor infant care services in Africa countries are more likely to increase the risk of HIV transmission to babies and patients inconsistency in care. However, an up to date record of stock in and stock out of HIV diagnosis materials will facilitate supply. While quick adoption of the orphans is effective measures to solve these challenges (Cawley et al., 2017 ).
HIV testing is the first important step to access treatment and prevent transmission of HIV infection. For this reason, the Department of Health South Africa introduced National HIV Testing Services Policy and Guidelines (2015). The policy goals are to utilise a comprehensive approach by working in collaboration with various health care services such as hospitals, local clinics, community centres, home visit and reached to target population. Thereby, reduce 50% of HIV transmission through HIV testing, deliver 80% of ARV, provide 70% continuous treatment and minimise 50% of stigma and discrimination among those living with HIV and AIDS (SDPH, 2015). Young adult leaners were educated to use a condo and avoid unprotected sex, early sexual activity, uptake HIV testing and treatment services (NDH, 2015). In 2017, 90% of people living with HIV in South Africa were aware of their HIV status (UNAIDS). However, Strauss et al., (2015) research, discovered that ignorance of HIV testing, stigma, discrimination from peers and families and fear of been HIV positive tested were the barriers encountered in the uptake of HIV testing. Secondly, lack of financial support, far distance to health facilities, long waiting in the queue and operating hours could affect classroom lessons and individual desire to attend HIV testing. Although to increase demand for HIV testing, people need to be enlightening about HIV testing and provided with emotional support to speak out of HIV status to their sexual partner. Moreover, delivering free HIV testing at mobile station facilities and introducing a multi-tasked strategy that could address the shortage of health care workers, promote confidentiality, high performance and flexible operating hours of health facilities could increase the number of HIV testing (Simukai, 2019).
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