The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic is one of the most serious contemporary sexual health related issue affecting the human race today. By the end of 2009, it was approximated that 34 million people were living with the HIV virus and deaths related to AIDS were about 1.8 million people. HIV/AIDS has been the worst pandemic since its discovery; having claimed over twenty five million lives by 2005 with the Sub- Saharan Africa being the most affected (Douek, Roederer & Koup, 2009). This paper focuses on the impact – psychosocial, cultural and economic of HIV/AIDS and its related sexual health problems on the individual as well as the community. HIV/AIDS has a huge impact on the infected individual’s family unit and the community they live in. The impact is dependent on the mode in which the virus is transmitted among communities (and who it infects), the diagnosis of infection, and the community setting in which the individual and family live.
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Introduction
Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS). Two strains of the virus, HIV-1 and HIV-2, have been described. AIDS is a human disease in which there is gradual failure of the body’s defence (immune) system thereby leading to severe and fatal opportunistic infections and cancers (Douek, Roederer & Koup, 2009). Infection with HIV occurs through coming in contact with infected body fluids such as blood, breast milk, and sexual fluids such as pre-ejaculate, semen and vaginal fluids. The key modes of transmission are unsafe sex with infected person-both heterosexual and homosexual, contaminated items such as needles and razors, breastfeeding, and infected mothers infecting the newborn during birth. Blood and blood products screening for HIV has greatly eradicated infections transmission through infected blood and blood products transfusions. HIV eventually progresses to AIDS; the individuals mostly succumb to opportunistic infections or malignancies resulting from progressive weakening of the immune system. Different individuals infected with HIV develop AIDS at different rates depending on the host, viral, and environmental factors; many develop to AIDS within ten years but in some it may be earlier or later. There is no cure for HIV/AIDS; treatment involves life-long use of a combination of anti-retroviral drugs and a cocktail of other drugs to treat any opportunistic infections (Douek, Roederer & Koup, 2009).
Infection with HIV usually has a huge physical, mental, social and economic impact on infected individuals, their families as well as the community in which they live. Stigmatization by other community members aggravates this impact; it hampers the prevention and management of HIV and impedes social support and disclosure of HIV status. The family units mostly affected by the HIV scourge are those of low socioeconomic status, such as drug users, asylum seekers and emigrants. The long-term impacts of living with HIV due to invention of better HIV care and management such as HAART (Highly Active Anti-Retroviral Therapy) have also evolved and changed many social aspects such as parenthood, disclosure HIV status and long term effects of the use of HAART on the individual. Another impact of the HIV is depicted in the inequality and discrimination individuals living with HIV experience when it comes to matters such as securing or sustaining employment and vital services like life assurance. Children have been known to bear the greatest impacts of HIV especially those orphaned and those infected with HIV. The number of orphans has been on steady rise due to AIDS-related deaths of the guardians and the fact HAART is ensuring infants born with HIV can live with the virus till they reach adolescence or beyond. All these factors collectively affect the community around them both socially and economically.
The Physical, Psychological and Social Impact of HIV on Individual and Families
Infection with HIV/AIDS leads to numerous bodily, mental and social issues that affect the individual and impacts on their families and communities at large. In the contemporary society, the definition of a family shifts from the traditional structure of biologically related members to include socially chosen relationships, for instance, close friends, partners, and close external family relationships such as homosexual men (Green, 2011). Before the discovery of anti-retroviral drugs, infection with HIV meant death within a short period of time. However, after the invention of HAART over a decade ago, there has been a gradual decline on the number of individuals succumbing to AIDS-related diseases in Australia, Europe and the United States. Currently, families have to deal with HIV infection as a chronic disease to be coped with for the life span of the infected individuals (Zuniga, Whiteside and Ghaziani, 2008). The requirement to take complex regime of many drugs is the foremost burden for the HIV-infected individual; many patients suffer anxiety, frustration, depression and hopelessness especially when the drugs do not accomplish or maintain the perceived benefits expected from the treatment regime. This could be due to virus mutation and individual resistance to the drugs (Zuniga, Whiteside and Ghaziani, 2008). It is documented that even when the treatment is effective, patients have other form uncertainties and distress.
The impact of the HIV treatment is further aggravated by other factors such as worry about employment, sexuality, the prospects of relationships, and the social reactions of other community members. HAART has numerous side-effects, such as cardiovascular diseases and several of which have psychosocial consequences like lipodystrophy (Zuniga, Whiteside and Ghaziani, 2008). Members of the family may also be burdened by giving care to the infected as the disease advances, and they may be distressed by the stigma often associated with HIV infection.
Another impact of HIV is the stigma and discrimination against persons living with HIV/AIDS. Apart from having to endure treatment with severe side-effects, they constantly have to cope with rejection and social discrimination. People with HIV/AIDS have to put with being labelled as “victims” a term that implies defeat, helplessness and dependence upon help from others (Matic, Lazarus & Donoghoe, 2006). The forms of stigma and discrimination vary geographically. Many nations have regulations that control the travel, entry and residence of persons living with HIV/AIDS. By the end of 2010, individuals living with the virus were restricted on long stays of over three months in sixty countries and eighteen of these even applied limitations on short term residence (Stutterheim et al, 2009) In healthcare sector, the common examples of stigma and discrimination experienced are being denied access to facilities and drugs, mandatory HIV testing without individual consent, and breach of confidentiality over the person’s status. In the workplace, stigma from employers and fellow workers include social isolation and mockery, or experience biased practices, such as dismissal or denial of employment (Stutterheim et al, 2009). Others instances include denial of entry into a country, forced eviction from residence by their families and rejection by colleagues and friends.
Stigma and discrimination associated with HIV/AIDS greatly hinders efforts to successfully battle the HIV and AIDS pandemic. This fear of discrimination frequently averts individuals from seeking treatment and management of AIDS or from publicly disclosing their HIV status. On numerous occasions, the stigma associated with HIV/AIDS can extend to the family and siblings of the infected individual, creating an emotional burden on those left behind. HIV/AIDS-related stigma modifies over time as infection levels, understanding of the disease and treatment availability vary. For instance, in the Netherlands, the community response to persons with HIV/AIDS is quite positive; understanding of HAART was linked to perception of lower risk, with a positive attitude towards gay people, less fear, and a greater readiness to have personal contact with people with HIV/AIDS. However, in Eastern Europe, discrimination may be more severe, particularly of specific groups, such as gays (Stutterheim et al, 2009).
Economic Impact of HIV
HIV/AIDS has had the greatest negative effect on the economies of many countries all over the world. The pandemic has been devastating for many nations where it has caused deep poverty both to the individual, families and community. The magnitude of economic and demographic impact of HIV/AIDS infection in third world countries is pronounced due to the fact that it affects persons in the most economically able and productive age. Besides, it is also weighing down on the economic and health gains made in the last few decades. People with HIV/AIDS create a profound burden for public finances, especially in the sector of health. In a number of Caribbean countries, HIV/AIDS patients take up as many as a quarter of existing hospital beds (Green, 2011). The sub-Saharan Africa is the most affected with southern Africa leading with the effects of the virus. The World Bank approximation shows that gross domestic product (GDP) of South Africa reduced by twenty percent in 2010 due to the effects of the deadly virus (Salinas & Haacker, 2006). Many other countries are using huge portion of their economic resources in providing treatment and care for people with HIV/AIDS. A research carried out by the University of the West Indies shows that the GDP of countries such as Trinidad and Tobago will drop by over five percent and that of Jamaica by 6.4 percent as a result of HIV/AIDS. The economic impact is poverty, a reduction in investments and savings, and rise of unemployment in vital industries such as agriculture and manufacturing (Salinas & Haacker, 2006).
The economic impact of HIV is greatly felt by the individual and their families. HIV/AIDS in many cases results in loss of income of the breadwinners and increase in expenditures as a result of caring for the infected. Families affected by HIV deplete their savings and assets in order to cope with increased expenditure and income shocks. Firm profits, savings and investments may reduce due to increase AIDS-related expenditure and lower labour productivity (Whiteside, 2008). According to ILO estimates, close to thirty seven million persons worldwide who are engaged in productive economic activities are HIV-positive. The mortality of these adults leaves the children as orphans and in cases where they were the sole bread winners; the children are left destitute (Green, 2011).
Impact of HIV on Parenthood and Children
The development of HAARTs has had an impact on pregnancy planning among people living with HIV. In the pre-HAART era, HIV-positive women were faced with their HIV status and the expected bleak outcome of death. The number AIDS-related deaths, however, has drastically gone down in women living with AIDS due to HAART; they now live longer healthier lives. Among the women in the reproductive age who are living with HIV, the decision about pregnancy is becoming an important one; this due to reduction of the risk of vertical transmission of the virus to the newborn (Noroski, 2009). Gains in prevention of mother to child transmission have led to emergence of new dimensions in the way communities view parenthood. Parenthood in HIV infected people is still eliciting many physical and social effects especially due to stigma and discrimination associated with the virus. Noroski (2009) outlines that concerns that might determine parenting decisions among people living with AIDS are the aspiration for parenthood, religious beliefs, children one had before, the position of spouse and health care providers, and apparent spouse capacity to parent successfully.
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HIV/AIDS has greatly changed parenthood. Research findings shows that close to seventy percent of all HIV infected parents regarded their family planning to be over, since they did not plan bear any more children, sixteen percent were undecided, while fourteen percent had an explicit longing to have more children (Wacharasan and Homchampa, 2008). Children who are infected with HIV either during birth or later through breast milk now have a chance to survive up to adolescence owing to better treatment regimes. This means that more adolescents increasingly have to cope with the virus. Children living with HIV/AIDS have a high risk of death from opportunistic infections. The virus affects the children psychologically and leads to neurological impairment; as a result they have pronounced cognitive insufficiency or diminished cognitive abilities, have behavioural difficulties, and have a general low quality life. Children living with HIV may also experience challenges in leading a normal life due to the medication they must use regularly as well as problems that result from disclosure of their HIV status (Noroski, 2009). The other main impacts of HIV on motherhood are ethical concerns about the possible danger of spreading the virus to the newborn, the socioeconomic impact, concerns and stigma associated with bringing up a child by a parent who has a potentially fatal disease.
The HIV/AIDS pandemic has greatly contributed to increase in the number of orphans universally. In Africa alone, there are over twelve million children orphaned by AIDS pandemic. The children are left destitute; at times the elder adolescents have to take up the parenting roles while majority are taken care of by their extended family members or foster parents. This long term care causes economic difficulties as financial resources are strained. The children become fully deprived of the care, guidance and protection of their parents and social problems begin to crop up. The children find themselves prematurely out of school. Statistics show that many of these children have to drop their education due to lack of resources, stigma and discrimination or simply to take up the role of premature parenting resulting from death of their parents. These effects are more pronounced especially after death of both parents. HIV/AIDS in the long term leads to numerous social impacts on the community such increase in crime rates, poverty, drug abuse, illiteracy, reduced productivity and eventual collapse of social system.
Impact of HIV on Caregivers and Healthcare Sector
The major burden of caring for the people living with AIDS rests with the family and the health care providers. In the era before anti retroviral therapy, this used to be an immensely stressing task because most of times the health of the infected patients deteriorated rapidly, they were bedridden and has to be taken care of. The advent of HAART has greatly improved the need for round the clock help since the patient can now lead a healthier life without need for much help. Important care givers are mainly the family, close friends and health workers.
The major impact of HIV on the caregivers is stigma; usually referred to as secondary stigma or stigma by association. Parents of people living with HIV may be held responsible for the ‘immoral’ behaviour that led to infection of their children with HIV. Wacharasan and Homchampa (2008) reported stigmatization as a primary concern for the caregivers. Rather than face stigmatization, caregivers may try to conceal their care giving activities by withdrawing from social relationships. In clinical practice, family caregivers may exacerbate demands of care giving by driving long distances to avoid community awareness of their care recipient’s HIV status. Some informal caregivers even avoid employing the professional home services of home health care, infusion therapy hospice, and hospice providers to avoid HIV/AIDS disclosure in their communities. Nurses working with informal caregivers fearful of status disclosure must be sensitive to the family’s caregiver’s fear of discrimination and stigma (Wight et al, 2006). Nurses, knowledgeable of ‘HIV friendly’ referral agencies with well established histories of providing confidential services can play a role in meeting the need for professional home-centred services and bringing solace to an informal caregiver fearful of HIV stigmatization.
Caregivers of HIV-infected children also face stigma. Thampanichawat (2008) found primary caregivers of children with HIV infection dealt with the stigma of AIDS while managing their anxiety and fear of loss. Bore much burden of care and faced many difficulties because of limited resources. Similar studies report increased financial difficulties, problems in child care and support and compromised help-seeking due to stigma. These findings emphasize the need to develop interventions to enable caregivers to seek out and identify financial resources and child care to support and empower caregivers to deal with stigma. Health care providers also may fears stigmatization in their work with HIV-positive patients. Caregivers, both formal and informal, commonly experience stigma from their association with HIV/aids and people living with it. This stigma may influence their willingness to work with those with HIV/AIDS or make their work more difficult.
Conclusion
Annually, across Australia and the world, many individuals get infected with HIV; thousands living with HIV develop AIDS. The impact of contracting and living with this virus hugely challenging and depends on the society the infected person lives in. The impact may determine the effectiveness of the management program, adherence to the treatment regimen and prevention of new infections. The major challenges are to encourage HIV testing for the risk groups, encourage status disclosure, availing a timely and effective management and care to all people living with HIV/AIDS, to endeavour in developing contemporary prevention methods that consider the variable patterns of the pandemic, and to eradicate the economic, physical and psychosocial impacts of HIV infection. Policies should incorporate the needs of individuals, families and the community in order to effectively address the impact of HIV on various sectors.
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