Essay on Communicable Diseases: HIV Threat, Agents, and Policies

This essay provides a literature review of HIV, a significant communicable disease, exploring its various aspects. It defines communicable diseases and focuses on HIV, detailing its impact, stages, and modes of transmission. The essay discusses the role of agents (retrovirus), host factors, and environmental influences on the spread of HIV, including socio-economic and climatic factors. It highlights the prevalence of HIV, particularly in Sub-Saharan Africa, and its impact on vulnerable populations, including the elderly. The essay also examines the importance of prevention methods, such as vaccination and mother-to-child transmission prevention. The essay emphasizes the importance of a holistic approach, including access to nutrition, healthcare, and improved living conditions, to combat the disease. The essay is a valuable resource for understanding the complexities of HIV and its management.

Running Head: COMMUNICABLE DISEASES
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Communicable diseases
10/31/2018

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The essay brings about the discussion on the literature review of the one of the
common emerging communicable disease threats, and the related aspects. Communicable
diseases refer to the infectious disease which is transmissible from one person to another by
any direct contact with the infected person, or through any indirect means. The indirect
means of transfer of disease can be through the discharge of the infected individual. There are
some of the common communicable diseases prevalent, such as Ebola, CRE, Flu, Hantavirus,
Hepatitis A, Hepatitis B, and HIV/AIDS. The medium through which these communicable
diseases spread depends upon the nature or the type of disease and the infectious agents
involved in the transmission of the disease (World Health Organisation, 2018).
For the purpose of the description of the communicable disease threat, HIV has been
chosen in this essay, and the aspects related will be included thereon. Thus, the essay will
include a description of the communicable disease, from varied, or multiple sources. There
will be also a discussion of the role of the agents, host, and the environmental factors
affecting or causing the occurrence of the disease to a human being. The potential policy or
the response to the widespread communicable disease is one of the important areas of
discussion in this essay.
Communicable disease threat – HIV
To discuss about the communicable disease treat, HIV it has been found that epidemic
disease in the beginning caused infection to people around 70 million people and 35 million
have died. HIV/AIDS refers to the spectrum of the health condition which is caused by the
infection from the Human Immunodeficiency virus. It refers to the communicable disease
which is caused due to human immunodeficiency virus, leading to damage to the body’s
immune system; the system which fights with the infections. It has been analysed that HIV is
the emerging and the fastest growing threat to the development of society around the world.
As there has been increase in the progression and the prevalence of the disease, thus the
factors or the effects are increasing too. Several research studies has demonstrated that people
found infected or positive with HIV, have oral fungal, bacterial and viral infections, which
often occurs in the initial period of the disease (Platt et al., 2016).
To discuss about the signs and symptoms of the HIV disease, it has been discovered,
that HIV infection has three main stages, acute infection, clinical latency, and AIDS. Acute
infection is the initial period which follows the contraction, which is known as acute HIV or

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primary HIV or acute retroviral syndrome. These symptoms include fever, rashes, headaches,
throat inflammation, tiredness, and the sores of mouth and genitals. The other symptoms may
also include diarrhoea, and other neurological symptoms. In the next level or stage, the
symptoms include weight loss, and the muscle pains. In the third stage of AIDS, there is an
increased risk of developing numerous viral induced cancers. In this stage, it has been found
that the people with AIDS have systemic symptoms that includes, prolonged fevers, sweat
especially during night. The other symptoms may include swollen lymph nodes, weight loss,
and the persistent weakness in the body (Bhatti, Usman & Kandi, 2016).
HIV positive is mainly found with those, one who have had unprotected sex, with an
infected partner, having oral sex even though the risk from the oral sex is considered low.
The other factors causing HIV includes, sharing of the drug needles with an infected person
by HIV infection, in which the virus passes on from an expectant mother to her child, during
or before the birth, or it may occur due to the blood transfusion of infected blood.
The diagram below describes about the prevalence and the global burden of the HIV
infection. It represents the statistics of HIV/AIDS in various regions of the economy.
HIV/AIDS globally, are found to be the 5th leading cause for the disability in the lives of
people in the parts of Africa and the Caribbean.

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(Source: School of Public Health, 2016)
HIV as a communicable disease has a higher prevalence in context to various
countries or communities which poses an impact on the people, especially older aged people.
According to Mokgele, (2014) has discussed about the HIV/AIDS in a manner which
describes the impact of the communicable disease on elderly, into the Sub-Saharan African
community. The authors states that human immunodeficiency virus and acquired immune
deficiency syndrome are found to be the greatest pandemic in the African community. The
virus and the syndrome has widely influenced and changed the role of the elder people in the
community. It has been found that around 22 million people, both children and adults are
living with this communicable disease. The reports from the analysis on the sub-Saharan
community, has evidenced that HIV is prevalent more with the older-aged people
(Lekalakala-Mokgele, 2014).
Discussing about the prevalence, it has been found that the Sub-Saharan Africa has
been found with highest HIV prevalence worldwide. These communicable diseases have been
emerged and re-emerged as major infections. The high risk of progression for HIV, is that
HIV-positive: >5mm = positive, and from the perspective of endemic countries: >10 mm is
positive. Studies in the article from the perspective of authors have revealed the fact that
HIV/AIDS have influenced majorly to the most reproductive and economically active section
of the African community. It changed the composition of the family by decimating the young
adult population, leading on to the increased number of elderly family headed and child-
headed families. The increase in the disease infection in elderly has been stated that they

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engage in the activities which increase the risks for HIV infection. Elderly people in those
communities are found to be engaged in the sexual activities frequently with the younger
people. This is turn increases the costs of care for the elderly people in the community, also
home-based care for the elderly people in these diseases is considered most effective. Thus
the authors has discussed well about the causes for the occurrence or spread of the infection
of HIV in respect to the sub-Saharan community (Hall et al., 2015).
Retrovirus is the agent in HIV (Human Immunodeficiency virus), disease infection is
which causes acquired Immunodeficiency syndrome (AIDS), infects and destroys, CD4+
cells of the human body. Due to this, the infection caused due to virus, limits host immune
responses, leading to infected patients, collapsing into opportunistic infections by any other
organisms. Host are the important factors as they play a vital role in determining the rates of
progression of the disease in the HIV infected individuals. In respect to this communicable
widespread disease like HIV, host is the person or the organism, which is capable of being
infected by a particular agent. Stating about the agent, it is referred to as the entity or micro-
organism, (virus or any bacteria) which is responsible for the occurrence of the disease.
Retrovirus is the agent which is necessary to be present for the occurrence of HIV infection to
the host or individual (Royo & Real, 2018).
Therefore, it is essential at first, that the agent must be present for the occurrence of
the disease. Describing environment, in relation to the epidemic like HIV, it refers to all the
things external to the host. The environmental factors are extrinsic, which affect the agent,
and the opportunity for the exposure. The physical factors include climate, biological factors
insects and other organisms, and the socio-economic factors, such as sanitation and access to
health services (Liu et al., 2016).
According to Talman, Bolton & Walson, (2013) it has been discussed that HIV/AIDS
is the epidemic which has been studied through social, economic, and political dimensions.
The authors have stated that in the regions of the world which is prone to HIV, the rates of
disease have been continuously increasing, due to massive environmental and societal
changes. The change in the global climate, human industries, and the shifting patterns of
migration due to poverty, inequality, and conflict are certain factors which influence HIV. It
has been found that the people with the rural livelihood are the most affected ones. Rural
livelihood is dependent on resources, technology, knowledge, health, and access to education
has been influenced due to this pandemic. People are unable to acquire or have access to

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these basic amenities of life, due to these diseases. It affects their economic or financial
condition, and creates burden on them, which further affects their education, hampering the
quality of life (Sudlow et al., 2015).
As poverty denies a person the access of education, medicinal facilities, which are the
factors that affect the occurrence and treatment of such epidemic diseases. Migration or the
climatic factors, as the extreme changes in the climatic conditions, sea-level rise, natural
calamities, and deteriorating agricultural productivity, affect the HIV/AIDS. As it has been
found that the large-scale migration is likely to increase the occurrence of the HIV disease.
Other environmental factors such as water, sanitation facilities, and livelihood insecurity are
also some of the crucial environmental factors, affecting HIV. For an instance, it is known
fact that food insecurity is a linchpin between the HIV and the environment. Therefore, it is
clearly understood that the individuals who are under-nourished are found to be more
susceptible to HIV infection. Another example can be of gender inequality as it places girls at
a higher risk for the HIV infection. However, the most important and common aspect of the
relationship of other environmental factors with HIV, is the consumer’s perspective.
Adequate access to the safe water and sanitation facilities is dispensable for the people living
with HIV. NAPWA (National Association of People living with HIV/AIDS) operates with an
objective to mobilise and facilitate care and support to the infected people. Thus, a more
holistic approach in fighting with the HIV/AIDS is to ensure that the people have access to
the basic nutrition, sound health care facilities, and the proper living conditions, to help
prevent the occurrence of such diseases (Schwartz et al., 2015).
The causes or the reasons behind the occurrence of the communicable disease, such as
HIV are also known as the transmission factors leading to poor health and wellbeing of the
person. The communicable infectious disease, such as HIV is spread through certain ways,
including sexual contact, exposure to the infected body fluid, or the tissues. The fluids such
as, blood (menstrual blood), semen/cum/ precum /ejaculate, vaginal secretions, and breast
milk. From the above bodily fluids, it is known that the highest concentration of the virus is
present in the blood, followed by semen, which is further followed by vaginal fluids, and then
leading on to breast milk. The HIV transmission from mother to the child takes place during
pregnancy, delivery, or breastfeeding this is termed as vertical transmission. Amongst all the
methods or mediums of transmission, it has been found that sexual contact or sexual

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intercourse is the one of the most common medium, between the people of opposite sex
(Hatcher et al., 2016).
One of the ways used is the vaccination given to the people to prevent the occurrence
or spread/transmission of HIV, from one person to other. At present there is no such vaccine
licensed for the disease like HIV, but the most effective vaccine which has been tried till date
is the RV144. The vaccine was introduced in the year 2009, but it has led to the partial
reduction of the risk of transmission nearly around 30% (Haynes & Burton, 2017).
Mother-to-child transmission of HIV is also referred as perinatal transmission of HIV.
A few cases where the transmission rates of HIV infection are found to be low, such as when
the HIV is detected early, in the case of women, during pregnancy or even before pregnancy
period. Giving HIV medicines to both, the child as well as the women, is the other method to
prevent the transmission from mother-to-child. To discuss the prevention of the infection
transmission from mother to the child, it includes several programmes; anti-retroviral
treatment to the HIV- positive pregnant women, preventing the infants from acquiring HIV
virus. The prevention of HIV transmission from the mother to the child can be done in a way
if the mother takes the medicines of HIV, during the period of pregnancy and child-birth. If
the baby after the birth is given HIV medicine, then the risk or possibilities of HIV infection
get reduced to 2% or lesser in some cases (Aids Info, 2018).
According to the Ishikawa et al., (2016), there has been a discussion or the study
conducted in Cuba and Thailand. A global guidance has been issued by WHO, based on the
criteria and processes of validation. The criteria have been set in order to eliminate the
mother to child transmission of the HIV infection. Antenatal screening and treatment is the
method which can resolve the problem of infection. Cuba is the first country to receive the
validation from WHO to eliminate the infection transmission from the mother-to-child. The
initiative to prevent the disease infection from the mother to child, the country focused on
voluntary testing, equality, and non-discrimination. Several treatment programs were also
conducted in Thailand, and the mothers in the country found infected with HIV, and their
exposed infants, are followed up and provided with the health facilities, to improve their
health condition. In both the countries, the infants are also monitored for the infection,
transmitted from their mother, which further followed the procedure of testing, diagnosis, and
proper treatment to them using different therapies and medicines (Cohn et al., 2016).

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Discussing about the treatment of HIV infection, it has been found that there is no
best treatment for HIV. Thus, the treatment consists of the highly active retroviral therapy
(HAART), that helps in reducing the rate of progression of the disease. From the year 2010,
more than 6.6 million people are found to be treated with this therapy mainly in the low and
middle-income countries. The treatment methods of HIV also constitute of preventive and
active treatment of opportunistic infections to the individuals. It has been analysed that ART
(Antiretroviral therapy), is recommended to all the HIV-infected individuals, after they are
diagnosed (van Heerden et al., 2017).
An antiretroviral drug reduces the transmission of the HIV through sexual contact,
between the individuals. If the drug is used consistently as pre-exposure prophylaxis, by
those who are not prone or infected by HIV, then the possibility of the infection amongst
those individuals reduces. Further, in the case, where an individual is found infected by HIV,
the use of antiretroviral drugs reduces the risk of the onward transmission. It is useful in such
cases also, where the sexual intercourse has been taken place without protection or ‘without
the use of condom’, and for the population which is repeatedly tested for HIV. The initiative
of ART therapy or drugs in all these cases proves to minimise the risk up-to a major extent
(Kay, Batey & Mugavero, 2016).
Arts & Hazuda, (2012) discussed about the aspects and effect of Anti-retroviral
therapy or drugs used for the HIV infection. The authors has described that the most
advanced treatment in the medical management of HIV-1 infection has been the
implementation of the ART therapy or drugs. Through the research study of these authors, it
has been analysed that HIV-1 acts as the causative agent, leading to AIDS. ART began more
than 20years ago, which was licensed as the first pharmaceutical agent for treating the HIV-1
infection. A total of 25-different anti-HIV-1 drugs from the six varied classes are available,
and these agents used in a combined manner, has resulted into reduced morbidity and
mortality associated with the disease. It has been found that HAART can supress the
replications for decades, by the proper and effective adhere, which can increase the life
expectancy of the HIV infected individuals (Günthard et al., 2016).
The therapy i.e. HAART cannot alone eliminate HIV-1 infection; as it is a chronic
condition for which there is no established cure or treatment. Thus, the authors in their study

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has mentioned about the negative aspects of the antiretroviral therapy, such as the loss of
appetite, fatigue, high cholesterol, changes in the mood, nausea and vomiting. In the United
States, it has been found that HIV was the leading cause of deaths in the people aged 25-44
years, in the past years. It has been stated that the 35% of the deaths are found to be caused
due to HIV only. Like other drug therapies, it has been analysed that the antiretroviral therapy
also faced resistance by the individual patients, failing therapies including those patients who
are found affected by these transmitted, drug resistant viruses. Therefore, resistance testing
is recommended to be used before the initiation of the HAART in the therapy naïve patients,
and even after the failure of the treatment (Cohen et al., 2016).
The potential policy response in context to the increasing communicable diseases like
HIV/AIDS includes the aspects of the government obligations, which states about the human
rights. These rights include the right to the protection of public health as it relates to the
policies and programmes designed to enhance health condition of the individuals infected
with HIV. According to Nunn et al., (2013) discussed about the policy responses of two
different countries, Brazil and South Africa. The two countries have different responses to the
acquired Immunodeficiency virus, and amongst these Brazil is considered as the model for
the policy response to the HIV/AIDS. The country has implemented several numerous
programmes, and offered anti-retroviral treatment to the people living with AIDS
(Oramasionwu et al., 2011).
From the research conducted, it has been analysed that due to the differences in the
responses to the policies formulated in these two countries, the epidemic has been evolved
over years. It has been studied and analysed from the study, that structural factors, which
includes politically salient ethnic divisions in South Africa are the determinants of these
policy response differences between both the countries. The Treatment Action Campaign was
founded back in the year 1998, in the country which aimed at enhancing the public policy
response to AIDS. In addition, several other factors, such as the availability of the financial
resources to the programmes conducted for the people living with HIV, had a great influence
on the policy makers, and different policy responses in South Africa and Brazil (Klein &
Flanagan, 2016).
To conclude the above discussion it has been analysed that the Human
Immunodeficiency virus (HIV)/AIDS, infectious disease has been wide-spread which has
caused negative impacts in resource limited settings. HIV is the life-long health condition,

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which influences the health and wellbeing of an individual. The disease must be prevented on
an individual level also, along with the medicinal care. Thus, the above essay presented the
causes, signs, symptoms, prevention and the treatment of HIV infection preventing leading to
AIDS in the later stage, causing threat to the lives of individuals.

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References
Aids Info. (2018) Preventing Mother-to-child Transmission of HIV. Retrieved from:
https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/50/preventing-mother-
to-child-transmission-of-hiv
Arts, E. J. & Hazuda, D. J. (2012) HIV-1 Antiretroviral Drug Therapy. Cold Spring Habor
Perspectives in Medicine, 2(4), 1761.
Bhatti, A. B., Usman, M. & Kandi, V. (2016). Current scenario of HIV/AIDS, treatment
options, and major challenges with compliance to antiretroviral therapy. Cureus, 8(3),
515.
Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy,
N. & Godbole, S. V. (2016). Antiretroviral therapy for the prevention of HIV-1
transmission. New England Journal of Medicine, 375(9), 830-839.
Cohn, J., Whitehouse, K., Tuttle, J., Lueck, K. & Tran, T. (2016). Paediatric HIV testing
beyond the context of prevention of mother-to-child transmission: a systematic review
and meta-analysis. The Lancet HIV, 3(10), 473-481.
Günthard, H. F., Saag, M. S., Benson, C. A., Del Rio, C., Eron, J. J., Gallant, J. E., ... &
Gandhi, R. T. (2016). Antiretroviral drugs for treatment and prevention of HIV
infection in adults: 2016 recommendations of the International Antiviral Society–
USA panel. Jama, 316(2), 191-210.
Hall, H. I., An, Q., Tang, T., Song, R., Chen, M., Green, T. & Kang, J. (2015). Prevalence of
Diagnosed and Undiagnosed HIV Infection--United States, 2008-2012. MMWR.
Morbidity and mortality weekly report, 64(24), 657-662.
Hatcher, A. M., Stöckl, H., Christofides, N., Woollett, N., Pallitto, C. C., Garcia-Moreno,
C.,& Turan, J. M. (2016). Mechanisms linking intimate partner violence and
prevention of mother-to-child transmission of HIV: a qualitative study in South
Africa. Social Science & Medicine, 168, 130-139.
Haynes, B. F. & Burton, D. R. (2017). Developing an HIV vaccine. Science, 355(6330),
1129-1130.

COMMUNICABLE DISEASES
11
Ishikawa, N., Newman, L., Taylor, M., Essajee, S., Pendse, R. & Ghidinelli, M. (2016).
Elimination of mother-to-child transmission of HIV and syphilis in Cuba and
Thailand. Bulletin of the World Health Organization, 94(11), 787.
Kay, E. S., Batey, D. S. & Mugavero, M. J. (2016). The HIV treatment cascade and care
continuum: updates, goals, and recommendations for the future. AIDS research and
therapy, 13(1), 35.
Klein, S. L. & Flanagan, K. L. (2016). Sex differences in immune responses. Nature Reviews
Immunology, 16(10), 626.
Lekalakala-Mokgele, E. (2014). Understanding of the risk of HIV infection among the
elderly in Ga-Rankuwa, South Africa. SAHARA-J, 11(1), 67-75.
Lekalakala-Mokgele,E. (2011) ‘A literature review of the impact of HIV and AIDS on the
role of the elderly in the sub-Saharan African Community’, Health SA
Gesondheid 16(1), 564.
Liu, A. Y., Cohen, S. E., Vittinghoff, E., Anderson, P. L., Doblecki-Lewis, S., Bacon, O. &
Liegler, T. (2016). Pre-exposure prophylaxis for HIV infection integrated with
municipal-and community-based sexual health services. JAMA internal medicine,
176(1), 75-84.
Nunn, A., Dickman, S., Nattrass, N., Cornwall, A. & Gruskin, S. (2013). The impacts of
AIDS movements on the policy responses to HIV/AIDS in Brazil and South Africa: A
comparative analysis. Global Public Health, 7(10), 1031-1044.
Oramasionwu, C. U., Matthew, K. R., Labreche, J. M. & Frei C. R. (2011). The
Environmental and Social Influences of HIV/AIDS in Sub-Saharan Africa: A Focus
on Rural Communities, Environmental Research, and Public Health, 8(7), 2967-2979.
Platt, L., Easterbrook, P., Gower, E., McDonald, B., Sabin, K., McGowan, C. &
Vickerman, P. (2016). Prevalence and burden of HCV co-infection in people living
with HIV: a global systematic review and meta-analysis. The Lancet infectious
diseases, 16(7), 797-808.
Royo, J. L. & Real, L. M. (2018). Genetic Association Studies in Host–Pathogen Interaction
Analysis. In Host-Pathogen Interactions (pp. 1-11). New York: Humana Press.

COMMUNICABLE DISEASES
12
School of Public health. (2016). The Global burden of HIV/AIDS. Retrieved from:
https://www.bu.edu/sph/2016/11/27/the-global-burden-of-hivaids/
Schwartz, S. R., Nowak, R. G., Orazulike, I., Keshinro, B., Ake, J., Kennedy, S. & TRUST
Study Group. (2015). The immediate effect of the Same-Sex Marriage Prohibition Act
on stigma, discrimination, and engagement on HIV prevention and treatment services
in men who have sex with men in Nigeria: analysis of prospective data from the
TRUST cohort. The Lancet HIV, 2(7), e299-e306.
Sudlow, C., Gallacher, J., Allen, N., Beral, V., Burton, P., Danesh, J. & Liu, B. (2015). UK
biobank: an open access resource for identifying the causes of a wide range of
complex diseases of middle and old age. PLoS medicine, 12(3), 1001779.
Talman, A., Bolton, S. & Walson, J. (2013). Interactions between HIV/AIDS and the
environment: toward a syndemic framework, American Journal of Health, 103(2),
253-261.
van Heerden, A., Barnabas, R. V., Norris, S. A., Micklesfield, L. K., van Rooyen, H., &
Celum, C. (2017). High prevalence of HIV and non‐communicable disease (NCD)
risk factors in rural KwaZulu‐Natal, South Africa. Journal of the International AIDS
Society, 20(2), 25012.
World Health Organisation. (2018). Oral health and communicable diseases. Retrieved
from: https://www.who.int/oral_health/action/communicable/en/