7056SOH MSc Global Healthcare Management

Introduction

Human Immunodeficiency Virus (HIV) is one of the most dangerous diseases that exist in the world and its cure has not been developed yet which makes it a serious threat. In this essay, a detailed analysis will be made on the various aspects of the disease along with its impact on the South African population.

Analysis of the impact of HIV on the South African population

Figure 1: Increasing rate of HIV in South Africa

(Source: Our World in Data. 2021)

Considering the above graph, it may be mentioned that the number of HIV positive patients is increasing every year in South Africa which is a serious threat to the country. On the other hand, it may be stated that South Africa has the largest HIV seropositive population in the whole world with an astonishing number of 7.2 million individuals (Satoh and Boyer, 2019). The HIV virus affects the human immune system which has a deep impact on the organs of the human body and the virus is transmitted through body fluids such as blood, breast milk, semen and vaginal secretions. It needs to be mentioned that HIV has become an epidemic in South Africa where adolescent girls and young women aged between 15 to 24 years become affected and the rates of transmission is higher in females than in males (Dellar et al., 2015). It may be opined that the increasing number of HIV patients in the country indicates the poor health conditions and lack of awareness among the population of the country (Afro, w. 2021). On a contradictory note, it may be mentioned that the rate of spread of HIV has been decreasing since 2015 due to the implementation of certain policies and people have started to follow the policies which has significantly reduced the number of newly infected people. Additionally, it may be implied that the number of adolescent patients is high and due to lack of effective treatment the death rates are high in South Africa according to the clinical records (Cluver et al., 2018).

However, it may be asserted that HIV has a profound impact on the growth and development of a country and South Africa is no exception to it where the economy of the country has been facing several challenges along with the erosion of civil order in the country. In addition to this, it needs to be opined that HIV has increased the number of orphans in the society where children have lost both of their parents due to HIV (Our World in Data. 2021). Furthermore, it may be implied that the normal life conditions have been affected severely due to the spread of HIV among the population of South Africa which has resulted in deteriorating social conditions. Apart from this, it needs to be stated that pregnant women have given birth to infected children which is a cause of concern for the country as it directly impacts the increasing number of HIV infected populations to a great extent.

Key policies and interventions and their impact

United States President’s Emergency Plan for AIDS Relief

Figure 2: HIV infection Graph

(Source: Data.unaids.org. 2021)

Considering the above graph, it may be opined that the number of newly infected persons in South Africa has been decreasing due to the successful implementation of successful preventive measure policies. Determined, Resilient, Acquired Immunodeficiency Syndrome (AIDS-free), Mentored and Safe (DREAMS) is a package of biomedical, social and economic intervention offered to young adults belonging to the age group of 10 to 24 years (Hensen et al., 2018). It may be mentioned that on World AIDS Day in November 2015 a collaborative approach was taken in order to confront the alarming situation that was prevailing in South Africa. An investment plan was made in order to fight the terrible epidemic of HIV in ten Sub-Saharan African nations which also included South Africa. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) collaborated with the foundations of Bill and Melinda Gates, Nike Foundation, Gilead Sciences, Johnson and Johnson and Girl Impact had made an announcement where it was declared that funds will be provided to Sub-Saharan countries including South Africa. The partnership which DREAMS promotes is essentially a multi-sectorial approach to reduce the number of HIV-infected persons in Sub-Saharan countries such as South Africa (Chimbindi et al., 2020).

The primary aim of this collaborative approach was to ensure better living standards where teenagers and young women may live with a strong determination, resilience and empowerment so that the females may lead a happy as well as protected life with their male counterparts. This was achieved through organizing several awareness programs in different parts of the country where governmental as well as nongovernmental authorities worked collaboratively to spread knowledge about the harmful consequences of unprotected sex. Sub-Saharan African countries have become the epicentre of the HIV epidemic where data gathered from strict surveillance shows the increasing rates of HIV-positive girls and young women has become a serious threat to the nation (George et al., 2020). On the other hand, it needs to be stated that through the preventive measures taken by DREAMS, an entire set of interventions targeting the behavioural, biological, social, cultural and economic sectors have been targeted through which desired changes in the society may be brought.

Additionally, it may be implied that DREAMS promoted developments in multiple sectors by introducing several interventions where common people were made aware of the terrible risk factors which may arise due to ignorance which includes lack of knowledge about the use of condoms among the larger sections of the society. In Sub-Saharan countries such as South Africa, girls or young women are more prone to getting affected by HIV than their male counterparts which makes women and teenagers vulnerable to HIV where gender-based violence is one of most essential factors which is responsible for this type of situation (Saul et al., 2018). Furthermore, it may be mentioned that interventions have become extremely vital in dealing with the issue of HIV in South Africa where the economic as well as social conditions are required to be enhanced in order to improve the overall healthcare system of the country.

Improving the conditions of AGWY

Adolescent Girls and Young Women (AGYW) are most vulnerable to HIV infections as gender-based violence is extremely common in South Africa which leads to this terrible problem that women face in the country. The spread of HIV is one of the most important issues that seriously disturbs the internal harmony of South Africa where female adolescents belonging to the age group of 15 to 19 years are getting affected rapidly (Topazian et al., 2020). On the other hand, it may be asserted that the number of infected girls is lower than males belonging to the same age group which makes the condition worse for adolescent girls and young women of the country. Several interventions have been started where the sex workers are being told about the harmful and dangerous consequences of indulging in unprotected sexual activities and the use of condoms is being promoted through several awareness programs in various parts of the country. The risk of transmission of HIV in young adults and women is significantly high in South Africa which reflects the structural flaws present in the society where DREAMS has made robust efforts to prevent the existing conditions to some extent (Birdthistle et al., 2018). Additionally, it may be opined that lack of empowerment of women is one of the most vital reasons which has negatively impacted the entire society where women do not enjoy equal employment opportunities which directly impacts the growth and progress of women in the country. HIV affects innumerable adolescent girls and young women in South Africa which also affects the mental health of adolescent girls and young women which ultimately impacts the social and economic parameters of the country to a considerable extent (Mthiyane et al., 2021).

However, it needs to be asserted that the number of violence that women face needs to be reduced as soon as possible which is closely interlinked with the spread of HIV in the country and in order to overcome this issue several post violence care units have been opened for providing best quality treatment to the victims. On a broader note, it may be implied that in economically weak countries the rate of adolescent pregnancies is high which often increases the number of HIV infected persons in a society which needs to be overcome through the use of several contraception services (Jonas et al., 2020). In addition to this, it may be added that the rate of violence needs to be reduced and the use of contraceptives are required to be popularized among adolescents and young women in order to further stop the further spread of HIV. In rural areas of South Africa, the number of HIV victims is increasing where young women indulge in unprotective sexual activities with old men which increase the mortality rate of the patients dying due to HIV (Stoner et al., 2019).

She Conquers core initiatives

It needs to be argued that the South African Government took the three year initiative in order to improve the conditions of adolescent girls and young women in June 2016 (Gov.za. 2021). The initiative was taken specifically to improve the deteriorating conditions of women of the country where young women and adults may get better opportunities in the field of public health so that the number of HIV positive cases may be controlled and reduced within a short period of time. The serious risk factors of HIV may never be neglected or overlooked as HIV is not a disease which has a clinical cure which makes it even more threatening where the immune system of the body gets damaged gradually (Siika et al., 2018). Moreover, it may be implied that the initiative focused more on controlling the rapid spread of HIV and the initiative was targeted towards adults belonging to the age group of 15 to 25. The primary aim was to make adolescent girls and young women aware of the harmful effects of the disease and several therapies were applied to the infected individuals in order to provide necessary information about the life cycle of HIV infection. It may be asserted that tuberculosis is one of the major factors which is responsible for the death of HIV patients in Sub-Saharan countries including South Africa (Reddy et al., 2019).

Furthermore, it may be opined that the core initiatives were introduced by forming a successful collaboration with stakeholders in order to spread awareness about the importance of maintaining a healthy sexual life. HIV has become a burden for South Africa where almost 70% of the population is affected by this disease and the infected individuals go through depressive disorders (Bigna et al., 2019). Additionally, it needs to be stated that women empowerment has a direct impact on the betterment of health conditions of women living in rural areas of the country where the rate of infection is significantly higher due to poor health conditions and lack of awareness among the AGWY. The prime concern of the program was to make women aware of the benefits of maintaining a healthy lifestyle while using several contraception services in order to stop the spread of the disease. HIV treatment needs to overcome several universal barriers and the quality of treatment needs to undergo changes so that better response is expected from the patient undergoing treatments (Havlir et al., 2019). Apart from this, it may be added that the initiatives are required to be monitored strictly in order to maintain the effectiveness of the campaigns throughout the country and especially in rural regions of the country where the rate of injection is comparatively high.

Description of the interventions aimed at reducing HIV by using DREAMS logic model or theory of change

Table 1: DREAMS logic model or theory of change

(Source: Self-Created)

Considering the above table, it may be asserted that several health campaigns have been carried out in several parts of the country in order to raise the awareness of people by spreading knowledge about the ways through which the disease is transmitted in a community. On the other hand, it may be stated that frameworks have been introduced where individuals will be able to test themselves whether someone is HIV positive or not (Regional Office for Africa. 2021). On a contradictory note, it needs to be opined that several Non-Governmental Organizations (NGOs) have come forward to spread awareness about healthy sexual activities which will certainly reduce the chances of getting affected by HIV to some extent. Factors such as social, economic, political and environmental factors directly impact the spread of HIV and these factors also become important in preventing the further spread of the disease (Gupta et al., 2008). Furthermore, it may be mentioned that the NGOs are working hard to spread awareness on sexual education which will clear the doubts of the adolescent girls and young women about the various ways through which the disease may spread rapidly. Moreover, it may be implied that South Africa is one of the economically weak countries which has low income which directly impacts the healthcare system of the country (Kremer et al., 2019).

Additionally, it needs to be argued that the use of AntiRetroviral drugs has been increased significantly which will definitely impact the country in a positive way as these drugs stop further multiplication of the virus in the human body. Various health campaigns have been conducted successfully in different parts of South Africa where the use of AntiRetroviral drugs is applied to the infected pollution. In recent years, the increase in the number of newly infected HIV patients has reduced, however, South Africa still has the largest HIV epidemic in the world which is highly alarming (Subedar et al., 2018). In addition to this, it may be asserted that DREAMS aims to reduce the number of HIV infections among adolescents and the program focuses on eliminating the discrimination that exists in society. The Government of the USA included the DREAMS program in the Government’s Country Operational Plans in South Africa in order to extend the two years’ time period which was previously set to achieve the goals (Usa.gov. 2021). However, it may be stated that the use of condoms and its benefits are actively being spread among adults in order to prevent the spread of HIV which is a reasonable step toward reducing the number of infected persons in society. Unprotected sexual activities play a huge role in the spread of HIV and it is one of the most common ways through which people get affected (Oliveira et al., 2017). Moreover, it may be added that the health and social care institutions have started a campaign where only one-time use of syringes is promoted and immediate disposal of used syringes are made mandatory. This step will certainly prove effective in the long term where disposal of used syringes will definitely help in reducing the number of HIV-positive patients in the country (Roth et al., 2021).

On a broader note, it may be implied that HIV is transmitted through indulging in sexual activities with more than two partners and extensive campaigns are made in order to spread awareness about the harmful effects of this type of activity. Several NGOs have been working in collaboration with other governmental authorities to spread awareness about the positive effects of leading a monogamous lifestyle. HIV prevention programs are being carried out extensively in several communities through careful implementation of policies among the vast population in order to stop the spread of the epidemic which will help the country in reviving its economic growth in the upcoming years (Chang et al., 2013). On a contradictory note, it may be mentioned that awareness among the sex worker of South Africa has been conducted thoroughly in order to further reduce the spread of HIV in the country. Furthermore, it may be added that a comprehensive approach was adopted in order to constantly monitor the activities of the stakeholders taking part in the awareness campaigns. Extensive as well as sustained efforts have been made in order to reduce the several risk factors which help in the transmission of HIV which is not a simple process to deal with (Coates et al., 2008). It has been observed that young women belonging to the age group of 15 to 24 years are at high risks of getting infected with HIV in South Africa due to poverty, intergenerational sex and violence against women (Muula, 2008).

Conclusion

From the above discussion, it may be clearly concluded that HIV has become a serious threat to South Africa however, it may be asserted that due to the implementation of several preventive policies and interventions, the rates of new infections have gone down significantly in the country since 2016 which is a positive indication for the well-being of South African people.

References

Afro, w. 2021. WHO AFRO AHO | REGIONAL OFFICE FOR AFRICA Health Observatory. [online] Aho.afro.who.int. Available at: <https://aho.afro.who.int/af> [Accessed 21 July 2021].

Bigna, J.J., Tounouga, D.N., Kenne, A.M., Djikeussi, T.K., Foka, A.J., Um, L.N., Asangbeh, S.L., Sibetcheu, A.T., Kaze, A.D., Ndangang, M.S. and Nansseu, J.R., 2019. Epidemiology of depressive disorders in people living with HIV in Africa: a systematic review and meta-analysis: Burden of depression in HIV in Africa. General hospital psychiatry, 57, pp.13-22.

Birdthistle, I., Schaffnit, S.B., Kwaro, D., Shahmanesh, M., Ziraba, A., Kabiru, C.W., Phillips-Howard, P., Chimbindi, N., Ondeng’e, K., Gourlay, A. and Cowan, F.M., 2018. Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol. BMC Public Health, 18(1), pp.1-15.

Chang, L.W., Serwadda, D., Quinn, T.C., Wawer, M.J., Gray, R.H. and Reynolds, S.J., 2013. Combination implementation for HIV prevention: moving from clinical trial evidence to population-level effects. The Lancet infectious diseases, 13(1), pp.65-76

Chimbindi, N., Birdthistle, I., Floyd, S., Harling, G., Mthiyane, N., Zuma, T., Hargreaves, J.R., Seeley, J. and Shahmanesh, M., 2020. Directed and target focused multi‐sectoral adolescent HIV prevention: insights from implementation of the ‘DREAMS Partnership’in rural South Africa. Journal of the International AIDS Society, 23, p.e25575.

Cluver, L., Pantelic, M., Toska, E., Orkin, M., Casale, M., Bungane, N. and Sherr, L., 2018. STACK ing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa. Journal of the International AIDS Society, 21(9), p.e25176.

Coates, T.J., Richter, L. and Caceres, C., 2008. Behavioural strategies to reduce HIV transmission: how to make them work better. The Lancet, 372(9639), pp.669-684.

Data.unaids.org. 2021. [online] Available at: <https://data.unaids.org/publications/irc-pub06/epi_update2005_en.pdf> [Accessed 21 July 2021].

Dellar, R.C., Dlamini, S. and Karim, Q.A., 2015. Adolescent girls and young women: key populations for HIV epidemic control. Journal of the International AIDS Society, 18, p.19408.Dellar, R.C., Dlamini, S. and Karim, Q.A., 2015. Adolescent girls and young women: key populations for HIV epidemic control. Journal of the International AIDS Society, 18, p.19408.

George, G., Cawood, C., Puren, A., Khanyile, D., Gerritsen, A., Govender, K., Beckett, S., Glenshaw, M., Diallo, K., Ayalew, K. and Gibbs, A., 2020. Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study. BMC women’s health, 20(1), pp.1-11.

Gov.za. 2021. South African Government | Let’s grow South Africa together. [online] Available at: <https://www.gov.za/> [Accessed 21 July 2021].

Gupta, G.R., Parkhurst, J.O., Ogden, J.A., Aggleton, P. and Mahal, A., 2008. Structural approaches to HIV prevention. The lancet, 372(9640), pp.764-775.

Havlir, D.V., Balzer, L.B., Charlebois, E.D., Clark, T.D., Kwarisiima, D., Ayieko, J., Kabami, J., Sang, N., Liegler, T., Chamie, G. and Camlin, C.S., 2019. HIV testing and treatment with the use of a community health approach in rural Africa. New England Journal of Medicine, 381(3), pp.219-229.

Hensen, B., Hargreaves, J.R., Chiyaka, T., Chabata, S., Mushati, P., Floyd, S., Birdthistle, I., Busza, J. and Cowan, F., 2018. Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe. BMC Public Health, 18(1), pp.1-10.

Jonas, K., Duby, Z., Maruping, K., Dietrich, J., Slingers, N., Harries, J., Kuo, C. and Mathews, C., 2020. Perceptions of contraception services among recipients of a combination HIV-prevention interventions for adolescent girls and young women in South Africa: a qualitative study. Reproductive Health, 17(1), pp.1-14.

Kremer, W.W., Van Zummeren, M., Breytenbach, E., Richter, K.L., Steenbergen, R.D., Meijer, C.J. and Dreyer, G., 2019. The use of molecular markers for cervical screening of women living with HIV in South Africa. AIDS (London, England), 33(13), p.2035.

Mthiyane, N., Harling, G., Chimbindi, N., Baisley, K., Seeley, J., Dreyer, J., Zuma, T., Birdthistle, I., Floyd, S., McGrath, N. and Tanser, F., 2021. Common mental disorders and HIV status in the context of DREAMS among adolescent girls and young women in rural KwaZulu-Natal, South Africa. BMC public health, 21(1), pp.1-12.

Muula, A.S., 2008. HIV infection and AIDS among young women in South Africa. Croatian medical journal, 49(3), p.423.

Oliveira, T., Kharsany, A.B., Gräf, T., Cawood, C., Khanyile, D., Grobler, A., Puren, A., Madurai, S., Baxter, C., Karim, Q.A. and Karim, S.S.A., 2017. Transmission networks and risk of HIV infection in KwaZulu-Natal, South Africa: a community-wide phylogenetic study. The lancet HIV, 4(1), pp.e41-e50.

Our World in Data. 2021. Our World in Data. [online] Available at: <https://ourworldindata.org/> [Accessed 21 July 2021].

Reddy, K.P., Gupta-Wright, A., Fielding, K.L., Costantini, S., Zheng, A., Corbett, E.L., Yu, L., Van Oosterhout, J.J., Resch, S.C., Wilson, D.P. and Horsburgh Jr, C.R., 2019. Cost-effectiveness of urine-based tuberculosis screening in hospitalised patients with HIV in Africa: a microsimulation modelling study. The Lancet Global Health, 7(2), pp.e200-e208.

Regional Office for Africa. 2021. HIV self-testing strategic framework: a guide for planning, introducing and scaling up. [online] Available at: <https://www.afro.who.int/publications/hiv-self-testing-strategic-framework-guide-planning-introducing-and-scaling> [Accessed 21 July 2021].

Roth, A.M., Tran, N.K., Felsher, M., Gadegbeku, A.B., Piecara, B., Fox, R., Krakower, D.S., Bellamy, S.L., Amico, K.R., Benitez, J.A. and Van Der Pol, B., 2021. Integrating HIV Preexposure Prophylaxis With Community-Based Syringe Services for Women Who Inject Drugs: Results From the Project SHE Demonstration Study. JAIDS Journal of Acquired Immune Deficiency Syndromes, 86(3), pp.e61-e70.

Satoh, S. and Boyer, E., 2019. HIV in South Africa. The Lancet, 394(10197), p.467.

Saul, J., Bachman, G., Allen, S., Toiv, N.F., Cooney, C. and Beamon, T.A., 2018. The DREAMS core package of interventions: a comprehensive approach to preventing HIV among adolescent girls and young women. PloS one, 13(12), p.e0208167.

Siika, A., McCabe, L., Bwakura-Dangarembizi, M., Kityo, C., Mallewa, J., Berkley, J., Maitland, K., Griffiths, A., Baleeta, K., Mudzingwa, S. and Abach, J., 2018. Late presentation with HIV in Africa: phenotypes, risk, and risk stratification in the REALITY trial. Clinical Infectious Diseases, 66(suppl_2), pp.S140-S146.

Stoner, M.C., Nguyen, N., Kilburn, K., Gómez-Olivé, F.X., Edwards, J.K., Selin, A., Hughes, J.P., Agyei, Y., Macphail, C., Kahn, K. and Pettifor, A., 2019. Age-disparate partnerships and incident HIV infection in adolescent girls and young women in rural South Africa: An HPTN 068 analysis. AIDS (London, England), 33(1), p.83.

Subedar, H., Barnett, S., Chaka, T., Dladla, S., Hagerman, E., Jenkins, S., Matshimane, G., Mangold, K., Msimanga, B., Pooe, R. and Schultz, L., 2018. Tackling HIV by empowering adolescent girls and young women: a multisectoral, government led campaign in South Africa. Bmj, 363.

Topazian, H.M., Stoner, M.C., Edwards, J.K., Kahn, K., Gómez-Olivé, F.X., Twine, R., Hughes, J.P., Cohen, M.S. and Pettifor, A., 2020. Variations in HIV risk by young women’s age and partner age-disparity in rural South Africa (HPTN 068). Journal of acquired immune deficiency syndromes (1999), 83(4), p.350.

Usa.gov. 2021. Health | USAGov. [online] Available at: <https://www.usa.gov/health> [Accessed 21 July 2021].