Public Health Intelligence Sample Assignment

Public Health Intelligence

TABLE OF CONTENTS
Title: ................................................................................................................................................1
INTRODUCTION ..........................................................................................................................1
Epidemiology of HIV/AIDS............................................................................................................1
Global presence of the disease ........................................................................................................4
HIV prevalence and demography within UK .................................................................................6
Factors influencing disease prevalence ...........................................................................................9
Critical evaluation of secondary data source used ........................................................................11
CONCLUSION .............................................................................................................................12
REFERENCES .............................................................................................................................14

Title:
Epidemiology of HIV/AIDS in England (United Kingdom) between the years 2009 and
2017.
INTRODUCTION
Human immunodeficiency virus popularly known as HIV/AIDS and is one of the most
significant cause of reducing mortality rates. According to the statistics present by World Health
organization, in 2017 there were 36.9 million people suffering with the disease (World health
organisation, 2019). The prevalence of the disease is greatly affected by the demography and
regional aspects. Since the disease is one of the most devastating chronic illness and does not
have any treatment which can provide complete cure it is vital that its epidemiological and
demographical aspects must be understood. It will help to improve the mortality rate in the
region (Reinhardt et al., 2017). This paper will discuss the epidemiology of HIV in United
Kingdom. It will also evaluate the factors which influences the prevalence and control of disease
so that necessary measures can be taken to control the disease.
Epidemiology of HIV/AIDS
Causes and distribution of HIV:
HIV is defined as the progressive diseases which leads continuous damage to the immune
system of body. The symptoms of this chronic disease may take one year or less than that to
appear. Gradually the HIV virus is transformed into its ultimate stage called acquired
immunodeficiency syndrome or AIDS which destroy the immune system. As a result of this
infected person becomes more prone to infections and malignancies which leads to death. At
present there are no remedies which can eliminate the disease completely but several treatment
methods are available which helps to slow down the destruction of immune system (Jangu, Tam
and Maticka-Tyndale, 2017). In the year 2017 there were approximately 101,600 people in
United Kingdom which are infected by HIV virus (HIV In the UK Statistics, 2017). Out of these
infected people the highest number of patients are diagnosed in Lambeth borough of England. In
Lambeth it is estimated that on every 1000 people around 15% people are below the age of 15
and are diagnosed with HIV (Progress towards ending the HIV epidemic in the United Kingdom,
2018).
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HIV is caused by the direct transmission of fluids such as semen, blood, breast milk and
genital secretions from the infected individual to others. The primary and common cause of HIV
is sexual intercourse with an infected person. The transmission of blood can also cause the
disease. For instance, the people suffering from haemophilia requires blood and thus the supply
of infected blood to such patients can make them HIV prone. Pregnancy related HIV
transmission is also one of the alarming situations for the individuals. Since the disease has
ultimate result of death it becomes essential that, the individuals who are not even born must be
protected from the infection. The HIV virus directly targets the immunity of human beings and
thus body becomes vulnerable to cancer and other life threatening infections. The continuous
destruction of immune system makes individuals immunodeficient. Gradually the reduced
functionality of immune cells functions which is measured by CD4 cell count results in AIDS
(Acquired immunodeficiency syndrome) AIDS is the common term which refers to development
of cancerous tissues and other clinical manifestations.
Diagnosis and testing services:
For the diagnosis of HIV enzyme immunoassays (EIAs) and other serological tests are
performed. A single test cannot provide the accurate diagnosis so these tests are performed in
combination. Serological tests does detect the direct presence of HIV virus instead these tests
determine the antibodies produced by healthy immune system (Davies, Ustianowski and Fox,
2016). The most challenging aspect of HIV diagnosis is to detect its presence among children
and infants. For the infants born from infected mothers in addition with serological test
virological test is also performed. Due to social stigma HIV testing services are not much
preferred by people. There is need to promote voluntary testing. Mandatory testing are violation
of human rights thus individuals must have self concern and awareness regarding this testing
procedures and needs. According to World health organisation HIV testing services must assure
that they follow principles such as confidentiality, informed consent, counselling, accuracy in
test results and connection with the care and treatment services (World health organisation,
2019).
The HIV virus can also transmit from placenta or the breast milk (Handiso, Negash and Mekiso,
2019). In order to avoid this severe risk, antiretroviral medications are provided to both females
and infants so that vulnerabilities can be reduced. The long-term exposure of antiretroviral
medications can help the infected individuals to eliminate even the sexual transmission of the
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virus. There have been several misconceptions among people that the virus is spread by
coughing or even casual contact like handshake or hugging. However, the virus is fragile and is
unable to survive outside the body (Grover et al., 2018). When the virus is detected in the early
stage then it is called as primary infection and it is possible for the health professional to delay
the occurrence of AIDS or final stage. Usually there is gap of around more than 10 years in
reaching from primary to final stage.
Control and prevention:
The foremost and critical prevention method for avoiding HIV is to follow the safe and
protected sex practices. It has been analysed that heterosexual individuals have high risks of
getting infected with the disease. Thus, it is recommended that individuals must get screening in
every three months so that the diagnosis can be performed on time and suitable control measures
can be taken. The taboo and social stigmas related to HIV must be addressed as the priority.
These stigmas are the main reason that individuals always try to escape the diagnosis or care
services. It is the responsibility of health care authorities to create awareness among people so
that they can understand the importance of on time diagnosis of the disease and the social
perspective related to disease can be changed (Reinhardt et al., 2017).
Voluntary medical male circumcision (VMMC) can be one of the effective prevention method
and it can reduce the heterosexual HIV risk by around 60%. The sex education along with the
information regarding condom usage and HIV testing can prevent the disease occurrence. The
people must be provided the counselling of HIV and other STIs so that they can understand the
risk factors and their prevention methods. For instance the use of male and female condom
during sex can eliminate the risk of HIV infection. It is estimated by WHO that the use of
condom can reduce the risk by 85% so individuals must be encouraged and informed regarding
their benefits.
For the prevention and control of the disease it is recommended that the sexual clinics
must be increased in different parts of UK so that HIV screening can be promoted and
encouraged. For instance, the mothers have high risk thus their diagnosis in the initial stages of
pregnancy can help to protect child from the infection. The regions which have high prevalence
must be tested with HIV so that on time control actions and services can be provided to them
(Guaraldi and Silva, 2016). The healthcare professionals and community servers must provide
necessary information and resources so that HIV risks can be eliminated. The health service
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providers must also enhance the HIV test monitoring and policies so that care services can be
improved and perspective of people towards disease can be changed.
Global presence of the disease
The prevalence of HIV is common in adults as well as among children. It has been
estimated by UNICEF that out of 36.9 million infected people nearly 3 million individuals are
below 20 years of age and it is assumed that every day around 4900 people are being infected by
the virus (Global and regional trends, 2018).
(Source: HIV/AIDS, 2019)
There has been continuous increase in the deaths caused by the HIV infection from 1990 and
were at peak in year 2015 (Guaraldi, Gomes and Silva, 2016).
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Illustration 1: Percentage of HIV prevalence
in different regions of world

(Source: Roser., M. and Ritchie., H., 2018)
From the graph it can be observed that with the efforts of World health organisation and
health departments of the nations there has been decline in the number of new infected people.
Like in year around 3 millions new infected cases were reported while in 2016 the number
reduced and only 1.8 millions infected people were recorded. The number of deaths due to HIV
has also decreased from 1.8 million to 1 million between year 2005 and 2016 by emphasis on
minimising the rate of infection in new born babies from their mothers. The infected people
within age group 15-49 years have shown maximum number of HIV associated deaths. Thus, it
is very essential that demographics must be considered in prevention and control methods of
HIV.
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Illustration 2: Global HIV statistics

(Source: Roser., M. and Ritchie., H., 2018)
The HIV prevalence rates also differs on the basis of gender. In many countries females
have higher rate of AIDS related deaths as compare to men. According to HIV In the UK
Statistics (2017) in UK only 31% of HIV victims are females while the infected men's account for
69%. One of the major causes for this difference is that in many societies’ women have very less
role in making sexual or protection decisions. Along with this lack of sexual education among
women is also critical aspect which makes them more vulnerable to the disease.
HIV prevalence and demography within UK
It has been reported in UK healthcare statistics that in 2017 around 93,385 people
received HIV care and the number of people seeking these cases have been increased by 54%
within 10 years (HIV In the UK Statistics, 2017). UK has small epidemic and prevalence of HIV
with near 102,000 people with HIV (HIV and Aids in the United Kingdom, 2019)). The HIV
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Illustration 3: Age group based death statistics of HIV sufferers

prevalence in UK also observes variations in terms of gender and ethical composition. Contrary
to global trends, in UK percentage of men suffering from HIV is higher than that of women.
HIV prevalence by gender in UK % of HIV infected people
Male 69.00%
Female 31.00%
(Source: HIV In the UK Statistics, 2017)
UK Community % of HIV
White 54.70%
Black African 29.10%
Black Caribbean 3.00%
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Illustration 4: % of males and female HIV infected
population in UK

Black other 2.90%
Asian 3.70%
Other/Mixed 5.40%
Along with British UK is home to several cultural groups such as African, Asian,
Caribbean and several other small groups. As per HIV In the UK Statistics (2017) HIV
prevalence is highest among white (54.7%) and African communities (29.1%) while Asians and
Caribbean groups in the region have less proportion in the infected communities (Crum-
Cianflone and Sullivan, 2017).
(Source: HIV In the UK Statistics, 2017)
Among majority of people in UK who are receiving HIV care are within age group of 55 and
above. It comprises around 33% of total UK population which is suffering from the disease.
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Illustration 5: Ethnicity percentage among HIV
infected people in UK

(Source: Progress towards ending the HIV epidemic in the United Kingdom, 2018)
It has been surprising that majority of people, around 91.6% patients receives HIV care in
England. Apart from England, Wales, Scotland and North Ireland are the major regions within
UK where care services are easily accessible and used by the patients.
(Source: HIV In the UK Statistics, 2017)
According to the statistics of public health England, there has been decline in the number of
people who are diagnosed with HIV over last few years. As per the 2017 statistics of HIV in UK,
number of diagnosed incidences has reduced by 17%. Sexual contact is the most common
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Illustration 6: Different age groups receiving HIV care in UK
Illustration 7: UK distribution of HIV

transmission route for the disease. In 2009 almost 95% of the HIV positive cases were reported
due to this mode of transmission (HIV and AIDS statistics, 2010). Though drugs and blood
products are also significant reasons for the transmission of disease but there has been decline in
such transmitted infection (Siuki et al., 2018). There has been routine screening of blood
products in healthcare organisations so that risk possibilities and vulnerabilities can be avoided.
It has been also analysed that some individuals diagnosed with HIV in UK originally got
infection from abroad.
Discussion
One of the reasons for high prevalence of the disease among native UK citizens as
compare to other communities is migration pattern. There has been less migration from the
countries which have higher prevalence of HIV. After the sexual transmission most commonly
factors which cause the HIV infection are drug injections and virus transmissions through blood
or other body tissues. This can be considered as the major challenge because for the regulatory
authorities it is vital to eliminate the infections particularly from mothers to their children (Jain et
al., 2015). There has been lack of awareness and sexual education which enhances the risk of
disease exposure. Due to negligence and lack of awareness most of the people in UK does not
consider it essential to diagnose the issue
Timely diagnosis is one of the key approaches to minimise the extent of this lifelong
chronic disease. However, the discrimination and stigma related to HIV make it uncomfortable
for majority of people to take necessary steps for diagnosis and treatment of the disease. It not
only increases risks and harm to the victim but also enhances the risk of infection transmission
among people.
Apart from the timely diagnosis the only effective way to avoid the prevalence of HIV is
to use safe approaches which can eliminate the disease occurrence. For instance, the protective
sex and blood transmission after proper evaluation and assessment can reduce the HIV
transmission to great extent.
The lack of sex education is one of the critical factor which affects the disease prevalence. For
instance the lack of sex education has caused increasing percentage of HIV vitcims in the age
groups of 15 to 49. As per the statistics presented by Roser and Ritchie (2018) in 2016 around
5,00,000 people were in the age group 15-49 who died due to HIV. The religious factors have
also impacted on HIV testing and related conceptions. For instance Muslim and African women
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in UK have higher prevalence of HIV. The sexual transmission is most common cause of HIV
and thus marital status and frequency of making sexual relations also influences the HIV
prevalence. As per the statistics provided by WHO the individuals who have low frequency of
sexual relations tends to have low risk of HIV. The use of prevention techniques such as condom
can also lower the risk of infection.
(Source: HIV and AIDS statistics, 2010)
The London has the highest percentage of diagnosis of HIV. The several regional factors
such as education level, availability of healthcare services and social structure plays an important
role in disease prevalence. The quality of health care services provided to the infected population
also plays important role in the control and prevalence of HIV. As discussed in above sections
the people beyond 55 years of age are also receiving the treatment and care services. UK has
excellent care services and HIV care are easily accessible within UK (Jamadar and Arifulla,
2015). It makes it easy for the sufferers to improve their quality of life by seeking care services
for both their mental and physical health.
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Illustration 8: Regional distribution 2009, of HIV diagnosis

Critical evaluation of secondary data source used
Secondary sources: For the study purpose different secondary sources have been used. The use
of reports from World Health Organisation and UNICEF helped to understand the severity of
HIV. However, in order to understand the epidemiology of HIV in UK context these sources
cannot be considered more effective. For the better evaluation of the study statistics and reports
from public health England have been used in the report. The data is collected from various
online sources and official websites of these agencies.
Sampling frame and size:The sample size cannot be defined because it is very wide as these
agencies regulate the health services across entire UK. Thus, entire UK population has been
chosen to demonstrate the HIV trends and diagnosis pattern.
Strength of sources used: In terms of reliability and validity the sources used are highly suitable.
The statistics provided by these agencies is also used by National Health service (NHS) to
develop the health care policies so that health outcomes of people can be improved. The
migration factor and variation in the education and income level is one of the factors which can
affect the prevalence factors.
Limitations: The secondary sources used in the study collects data at broad level so these facts
are neglected. It can be considered as the limitation of the study. The study has limitations and
weaknesses because the use of secondary sources provides wide range of information and thus it
imposes a barrier to effectively merge and analyse all information in one specific direction. The
vulnerability of the HIV is equal among all age groups though each have different mode of
transmission. Thus, all age and gender groups are included in the study. However, the migrants
which are living in UK only from the purpose of seeking HIV care services are not considered
separately. This element can cause fluctuation in the actual estimation of diagnosed individuals.
HIV is considered as the taboo thus most of the people used to avoid the issue (Guaraldi
et al., 2016). Hence, the statistics and facts discussed in the secondary sources are completely
estimation not the exact data. It can be taken as another limitation of the study. The most
challenging aspect for the secondary sources is to collect the data. Unlike other health issues HIV
is not discussed openly and freely by communities. Thus, data collected in the study is only an
approximation and cannot be analysed as the realistic values.
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CONCLUSION
From the study it can be concluded that it is mandatory for the government authorities to
focus and understand the epidemiology of HIV/AID. It will help in formulating the effective
strategies for prevention and control of the disease. Thus, it is also recommended that social care
must also be integrated with the public health so that both physical and mental health of HIV
patients can be improved. It can also be concluded from the report that public health goals cannot
be achieved without joint efforts of communities, healthcare service providers and regulation
authorities. Thus, it has learned from the study that HIV prevalence can be controlled and
prevented by using suitable prevention techniques and testing measures. It can also be concluded
that voluntary testing, counsellings and easy access to treatment methods are required so that
deaths related to HIV can be reduced.
REFERENCES
Books and Journals
Crum-Cianflone, N.F. and Sullivan, E. (2017) Vaccinations for the HIV-infected adult: A review
of the current recommendations, Part I. Infectious diseases and therapy. 6(3). pp.303-331.
Davies, O., Ustianowski, A. and Fox, J. (2016) Pre-exposure Prophylaxis for HIV prevention:
Why, what, who and how. Infectious diseases and therapy. 5(4). pp.407-416.
Dias, S. and et al., (2018). Implementation Process and Impacts of a Participatory HIV Research
Project with Key Populations. BioMed research international. 2018.
Grover, S. and et al., (2018) Reduced Cancer Survival Among Adults With HIV and AIDS-
Defining Illnesses Despite No Difference in Cancer Stage at Diagnosis. JAIDS Journal of
Acquired Immune Deficiency Syndromes. 79(4). pp.421-429.
Guaraldi, G., Gomes, A.F. and Silva, A.R. (2016) HIV Associated Non-AIDS Conditions in
Patients Aging with HIV. In Managing the Older Adult Patient with HIV (pp. 19-52).
Adis, Cham.
Handiso, A.A., Negash, Y. and Mekiso, G.T., (2019) Modeling Time to Death of HIV Infected
Patients on Antiretroviral Therapy in case of Hossana Queen Elleni Mohammad
Memorial Hospital, South Ethiopia. International Journal of Public Health. 5(1). pp.071-
082.
Jain, S. and et al., (2015) Surveillance of tuberculosis co-infection among HIV infected patients
and their CD4+ cell count profile. Asian Pacific Journal of Tropical Disease. 5(3).
pp.234-238.
Jamadar, N. and Arifulla, M. (2015) HIV, Tuberculosis. PULMONARY TUBERCULOSIS CO-
INFECTION AMONG HIV INFECTED PATIENTS: A HOSPITAL BASED STUDY
FROM BIJAPUR, SOUTHERN INDIA, (6931).
Jangu, N.W., Tam, A. and Maticka-Tyndale, E. (2017) Challenging HIV vulnerability discourse:
the case of professional and entrepreneurial women in Dar Es Salaam, Tanzania. Culture,
health & sexuality. 19(5). pp.572-586.
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Reinhardt, S.W. and et al., (2017), December. AIDS-defining illnesses at initial diagnosis of HIV
in a large Guatemalan cohort. In Open forum infectious diseases(Vol. 4, No. 4, p.
ofx249). US: Oxford University Press.
Siuki, H.A. and et al. (2018) Health education intervention on HIV/AIDS prevention behaviours
among health volunteers in healthcare centers: An applying the theory of planned
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Online
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HIV and AIDS statistics (2010). Available at: http://www.nhshistory.net/aidsdata.pdf (Accessed:
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HIV In the UK Statistics (2017). Available at: https://www.nat.org.uk/we-inform/HIV-
statistics/UK-statistics (Accessed: 24 March 2019).
World health organisation (2019). Available at: https://www.who.int/hiv/data/en/ (Accessed: 24
March 2019).
Progress towards ending the HIV epidemic in the United Kingdom (2018). Available at:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/
attachment_data/file/759408/HIV_annual_report_2018.pdf (Accessed: 25 March 2019).
Roser., M. and Ritchie., H. (2018). HIV/AIDS. Available at: https://ourworldindata.org/hiv-aids
(Accessed: 24 March 2019).
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https://www.avert.org/professionals/hiv-around-world/western-central-europe-north-
america/uk (Accessed:19 April 2019).
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