8PRIMARY HEALTH CARE Essay Example
8PRIMARY HEALTH CARE
HIV/AIDS and How Community Nurses
Can Use the Primary Health Care Principles of Equity And Access
HIV/AIDS and How Community Nurses
Can Use the PHC Principles of Equity and Access
Primary health care refers to an essential health care founded on practical, research-based and socially satisfactory methods that are meant to be accessible universally to people and families in the wider community depending on their optimal participation as well as at a relatively reasonable price that is affordable to all (Whitehead, n.d.). It also comprises the essential elements for promoting health and preventing illness and injuries. Usually, primary health care (PHC) is considered in patient care as the initial point of contact with the national health system for an individual, a family of a community, and hence serves to make health care equitable and accessible to all (Whitehead, n.d.). In Australia, primary health care is designed to include interconnecting principles of access and equity, in addition to other elements like inter-sectoral cooperation, self-determination of communities, and empowerment (Thomas et al., 2015; Keleher, 2001). It is argued in this paper that after the discovery of antiretroviral therapy, a capacity to access treatment, care and community nursing interventions and approaches has become comparable with a capacity for survival for those infected with HIV. This paper discusses the principles of equity and access to primary health care. It also describes key sub-populations at risk of HIV infection who face significant problems in accessing treatment. Also discussed include community nursing interventions and approaches that can be provided to the affected sub-populations to promote their health.
Equity and access are valuable aspects of providing primary health care to individuals at risk or those affected by HIV/AIDS. The Alma-Ata Declaration, which was adopted in 1978, propositioned the primary health care approach as a key strategy for strengthening health systems (Chan, 2008). One of the features of the Declaration is that it recommends equity and social justice in access to primary health care. Hence, its underlying goals include achieving equality in access to care. The HIV/AIDS epidemic indicates the significance of equity and universal access to primary health care significantly (Pillay, 2008).
Equity means that primary health care should be anchored in equal expenditure per capita. This implies that an equitable allocation is attained when health service budget is divided equally among geographical areas depending on the population size of a given area. Put differently; an equitable health service serves to ensure that all people, regions and social groups are provided with the same level of health care (Whitehead, n.d.). In this case, unequal access to HIV/AIDS treatment would arise when individuals are not able to use health services as a result of economic status, age, religion or gender. Inequity in access would also come about when primary health care resources are unequally distributed across the country, or concentrated in urban and more developed areas than in the rural areas. Inequity in access also occurs when a country’s existing finances resources are allocated fully on high-tech medical services intended to cater to the needs of a small population segment, yet little provisions are made to ensure the health care services are sufficiently balanced for the benefit of the majority. A category of people may fail to benefit from health services or even only get to access them too when it is relatively late, or when the cost of health care is high (Keleher, 2001).
The key sub-populations identified to be at risk of HIV infection include sex workers, men who have sex with other men and transgender people, prisoners and drug injectors (World Health Organisation, 2010;2016). Recorded infection is mostly restricted to persons with higher-risk behaviour such as drug injectors, men who have sex with other men and sex workers. According to WHO (2010), HIV incidence has not constantly surpassed 5percent in any distinct sub-population. A concentration of HIV epidemics has been found to have multiplied fast in defined subpopulations although it is not effectively perceivable in the general population. In respect to primary health care, the health sector is in charge of configuring and providing support to service delivery models designed to attend to the health needs of populations that are most-at-risk for HIV. They also ensure that primary health care services are equitable, acceptable, and accessible. Men who have sex with men, drug injectors and sex worker are particularly at risk for inequitable access to primary health care. This is because both kinds of sub-population face significant levels of stigma in the society. They are also criminalized. Overall, stigmatization and criminalization are two fundamental factors that discourage them from gaining access to health services, apart from increasing their high-risk behaviours.
When it comes to community intervention, when it is not possible to serve all individuals in need of HIV treatment, provision of the treatment services need to be directed by principles of equitable access and social justice (Macklin, 2004). This would amount to providing ARV treatment free of charge to the affected subpopulations, such as sex workers, prisoners, drug injectors, and MSMs and transgender people through their most accessible public healthcare facilities. At the same time, pre-exposure prophylaxis (PREP) that contains antiretroviral therapy should be served to them, as this would offer extra prevention alternative key populations as a component of HIV prevention approach. At the same time, Post-exposure prophylaxis (PEP) should be provided to them at their most accessible health care facilities (WHO, 2016). Overall, it is significant that these sub-populations should have the same level of access to antiretroviral (ART) and ART management in the same degree as other populations (WHO, 2016).
Sex workers are at risk of HIV infection. They are considered by WHO (2010) to be among the most vulnerable groups HIV, as well as among the most affected subpopulation by HIV. Certain behaviours make sex workers and their clients particularly at risk, which aggravates their vulnerability to HIV infection. There is a strong evidence base that suggests some nursing interventions for prevention of HIV transmission among sex workers, which also seeks to provide primary care and empower sex workers in ways that can improve their health and well-being. Nurses can tailor interventions for brothel or even for more informal home- and street-based settings through sex worker programmes, which promote condom use among sex worker. According to WHO (2010), there is sufficient evidence showing the degree to which programmes intended to promote condom use have been effective in reducing HIV infection among sex workers. Nurses should also participate in programme planning consisting of formative assessments designed to investigate and discover the nature of vulnerabilities of sex workers and their health needs. Nurses should also invite sex workers to participate in the delivery of programmes (WHO 2016). At the same time, nurses should promote the use of water-based lubricants for male sex workers. There should also be educational programs and communication campaigns targeted at sex workers through peer outreach. The educational programs should also encourage sex workers to find out about their HIV status. Nurses should also encourage sex workers to prevent transmission of HIV using drugs. Sex workers should also be provided with social support. Examples of social support include legal services and generation of income. The HIV prevention activities should be made accessible to sex workers at health facilities. Alternative delivery methods could include peer outreach and community-based settings.
Men who have sex with men (MSM) are also at risk of HIV infection. There is significant research data much on HIV prevalence among men who have sex with men (MSM) and transgender people in developed nations like Australia. Current evidence shows that sexual transmission of HIV among MSM is re-emerging as a health predicament in the country. Studies have also established that many MSMs are either married or also have female partners. Still, one of the significant factors leading to inequitable access to treatment options among MSM and transgender people is that they have to contend with significant stigma or are forced to hide in their health predicament as a result of criminalization. At any rate, nurses still have a significant role to play through an inclusion of services for MSM and transgender people to be a part of their intervention programmes. The nursing programme planning should be adjusted to take account of formative evaluations that could be applied in determining the health risks and requirements of MSM and transgender people. Individuals who are affected should be encouraged to participate in the design and implementation of the interventions. Priority interventions that target MSM and transgender people toward preventing sexual transmission of HIV should encourage them to use condoms, as well as water-based lubricants. They should also aim at encouraging MSM and transgender people to test for their HIV status. They should also encourage the use of drugs intended for to help in the prevention of HIV transmission. Nurses should be at the frontline of encouraging community-based behaviour change by taking part in the distribution of brochures and posters in hospitals and other settings perceived to be a regular entertainment or meeting point for MSM and transgender people.
Drug injectors are also at risk of HIV infection. According to WHO (2010), in places where people have a tendency to inject themselves with drugs, implementation of a broad combination of interventions that can assist in preventing HIV, as well as treating and caring for injecting drug users (IDUs). In spite of the overwhelming public health evidence that demonstrates the efficiency of such interventions, a large number of policymakers have been hesitant to put into practice or upgrade such interventions as a result of their tendency to be controversial. Nurses should engage in concentrated advocacy to instigate and maintain harm reduction programmes. On the other hand, WHO (2010) suggests that in situations where barriers to implementation of harm reduction interventions exist, there is a need to advocate for supportive policies that can facilitate equitable access to HIV prevention and treatment for the IDUs. Similarly, there is a need to implement suitable models of service delivery to direct effective execution of harm reduction programmes. This may include procurement and distribution of opioid agonist medical drugs like methadone, which demand extraordinary measures and processes. Examples of harm reduction programs that nurses can help implement comprise treatment of their drug dependence, specifically through opioid substitution therapy. Other interventions include providing the IDUs with targeted information regarding the risks they are exposed to by sharing syringes and needles, encouraging them to check their HIV status. At the same time, starting a community-based outreach is necessary, as it can help deliver HIV prevention, care and treatment measures for drug injectors. They should also be provided with antiretroviral therapy. Needle and syringe programs should also be started to provide them to make sterile injecting equipment accessible to them.
Prisoners are also at risk of HIV/AIDs infection. According to WHO (2010), prisons are major points of contact, as people from diverse backgrounds are confined to a setting. In such settings, many people live with HIV and are at high risk of HIV infection. It is significant that all people should be provided with equitable access to preventing HIV infections in prisons and treating and caring for people with HIV. They are entitled to the same standard of health as all other members of society. A wide range of services is required for people in prisons and similar settings, including condom distribution, clean needle and syringe provision, opioid substitution therapy, HIV testing and counselling, provision of antiretroviral therapy and treatment for sexually transmitted infections. Prison authorities should work with people in other branches of the criminal justice system and with health authorities and nongovernmental organizations to ensure continuity of care, including antiretroviral therapy (ART), from community to prison and back to the community, and also between prisons. Summary of recommendations Prisons and other closed settings should offer a full range of HIV prevention, treatment and care services and commodities, including HIV testing and counselling and ART.
In conclusion, after the discovery of antiretroviral therapy, a capacity to access treatment, care and community nursing interventions and approaches has become comparable with a capacity for survival for those infected with HIV. Equity and access are valuable aspects of providing primary health care to individuals at risk or those affected by HIV/AIDS. The key sub-populations identified to be at risk of HIV infection include sex workers, men who have sex with other men and transgender people, prisoners, and drug injectors. Still, one of the significant factors leading to inequitable access to treatment options among this sub-population is that they have to contend with significant stigma or are forced to hide in their health predicament as a result of criminalization. Community nurses should ensure that primary health care services for those infected with HIV/AIDS are equitable, acceptable, and accessible. At any rate, there is still a concern that such interventions alone have minimal implications regarding ensuring equitable access to HIV prevention, care, and treatment measures. Therefore, policy-makers should clamour for wide-ranging interventions, which should be gradually upgraded to ensure that they cater to all drug users over time. The interventions should be adjusted to fit the drug-use patterns of specific areas.
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