NUR3800 Sexual Health and wellbeing

School of Health and Education - Assessment Submission Sheet

SEXUAL HEALTH AND WELLBEING

TOPIC: HIV 

Student No: 

Name of Programme:  Adult Nursing

Module No:    NUR3800

Module Title: Consolidating Expansive Learning

Name of Field Leader: 

Title of Assessment: Consolidating Expansive Learning Assessment document

Word Count: 

Campus: 

Date Assessment due: 

Date Assessment Submitted: 

Mode of Submission:       Electronic Submission via Turnitin

Declaration of Academic integrity:

1. I confirm that this is all my own work and that any information copied in part or full including references and quotations from both primary and secondary sources have been fully identified and properly acknowledged in line with the Guidelines on  Referencing and Citation Style in Health and Social Science  (http://unihub.mdx.ac.uk/Assets/hss.pdf )

2. I have read the regulations relating to academic misconduct and submit this work as my own in line with those regulations. (http://unihub.mdx.ac.uk/study/assess/index.aspx )

3. I understand that my work may be compared against the work of others for the purposes of detecting plagiarism and collusion. When software is used for this purpose, I am aware this will mean it will be held on a (secure) external database for the sole purpose of detecting plagiarism. When requested by the module tutor, I agree to provide an electronic copy of the work.

4. This work has not been submitted previously towards any credit bearing component of an award.

5. I have read the ‘Confidentiality Statement’ as it relates to assignments on clinical practice in my programme handbook and have ensured that my assignment complies with this statement.

Please sign and enter your student number here to confirm adherence to the above:

Signed:  

Student self-assessment

What I have done well:  Providing  an in-depth analysis of UK’s effort to  tackle HIV and reduce  new infections

What I found challenging: Synthesizing the resources to capture what I have learned from the course material

What I would like specific feedback on: How to improving my writing and focus on key points

Consolidating Expansive Learning Assessment template

• If you undertook the volunteer pathway please add a screen shot of your completed hours, signed off here.  
• If you took a ‘deep dive’ module please add a  screen shot of your completed MCQ here.  

If you choose to submit using a recorded 10 min presentation, you must use the template provided on your module page.

Image of the artefact produced in response to your learning. It must relate to a health and social care problem where nurses have a role in supporting wellbeing and draw on the NMC guidelines to critically appraise your professional identity as nurse. Please note your artefact is an essential component of your critical reflection. Explain what the Image of the artefact means to you 

(100 words). And Reference it.

Source: https://www.hiv.gov/hiv-basics/overview/making-a-difference/supporting-someone-living-with-hiv

 The image of the artefact emphasizes the importance of listening to the needs of people diagnosed with HIV. Additionally, the artefact highlights the need to learn about the disease, including its transmission, treatment, and how individuals can lead a healthy life after being diagnosed with HIV.  I also chose the artefact because it encourages HIV treatment and medication adherence.  People who adhere to the treatment regime reduce HIV virus in their blood to undetectable levels, stay healthy, and live long. The artefact also encourages HIV individuals to pursue necessary support to ask questions, address anxieties, and concerns that one may have regarding HIV. 

Step 1: What? 

 Task: Describe Your learning experience on HIV (approx. 350 words).

 I chose HIV topic because the disease affects individuals from all ethnic and racial backgrounds.  However, I learned that some groups are disproportionately impacted by the disease.  For instance, black Africans, migrants, bisexual men and gay, those injecting themselves with drugs, and the Caribbean ethnic communities are disproportionately affected by HIV (Positive Voices 2018).  Nonetheless, HIV is no longer a life-threatening condition because it can be managed with regular check-ups and medication.  For instance, antiretroviral therapy (ART) manages HIV infection and suppresses the viral load (MedlinePlus, n.d; HIVinfo 2021). The drugs are grouped into six classes: integrase inhibitors, fusion and entry inhibitors, protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs) and Nucleoside reverse transcriptase inhibitors (nukes or NRTIs)( Terrence Higgins Trust 2020).  Guidelines recommend combination of these classes depending on the patient’s lifestyle and health needs (HIV i-Base 2022). Those who think they have been exposed to HIV are prescribed PEP (post-exposure prophylaxis) medicine to safeguard them from being infected (BHI VA/BASHH 2018; Malani 2016). PEP should be prescribed 72 hours after getting contact with the HIV virus (NHS, n.d). However, without treating HIV, the virus advances and becomes worse with time. Terrence Higgins Trust (2020) categorizes HIV infection into four stages: seroconversion illness/ Acute or primary infection, the asymptomatic stage, symptomatic HIV, and Late-Stage HIV/AIDS. Some individuals get ill for a short time after contracting HIV while others become severely ill and may require doctor’s attention.  At the seroconversion stage, the disease is very infectious.  In the asymptomatic stage, people feel okay and may not witness any symptoms. The second stage may last several years. However, the virus remains active, make copies, infect new cells, and undermine the immune system’s ability to fight diseases (Terrence Higgins Trust 2020).  In the symptomatic phase, one becomes vulnerable to developing infections due to a damaged immune system. The late-stage HIV/AIDS causes significant damage to the immune system, one gets exposed to cancers and opportunistic infections. These are AIDS-defining illnesses, including pneumonia, tuberculosis, and cancer. 

 Despite advancement in HIV treatment, those diagnosed with the disease continue to be stigmatized and discriminated against. Wiginton et. al.(2021) notes that People living with HIV (PLWH)enact, anticipate, and internalize stigma.  Those who internalize HIV-related stigma record poor health outcomes because they feel rejected and mistreated because of their status (Earnshaw et al. 2013). The interaction between internalized stigma and community stigma leads to adverse outcomes among PLWH (Turan et al. 2017).  Consequently, stigmatized individuals feel inferior that the rest of society because some members of the public maintains that people living with HIV deserves their illness and should be Quarantined because they feel uneasy getting close to them (Hedge et al. 2021).  Therefore, public awareness about HIV is necessary to address the stigma faced by individuals living with HIV.

Step 2: So What?

  Task: Describe why this leaning experience was significant to you as a student nurse (approx. 800 words)

The learning was significant to me as a student nurse because I gained significant insights about HIV and what the UK is doing to prevent and manage the disease.  For instance,   I learned that new HIV infections peaked in the United Kingdom in 2014.  However, the country between 2014 and 2018 has witnessed a significant decline in new HIV incidences and diagnosis.  For instance, the rate of infections declined from 6,278 to 4,453 between 2014 and 2018(Public Health England 2019). The decline was significant among GBM (gay and bisexual men). The diagnosis in this population segment dropped by 35%, from 3,480 to 2,250 between 2014 and 2018.  However, the steep fall was among white GBM conceived in the United Kingdom, living in London and between ages 25 and 49 years. Public Health England(2019) further notes that new HIV infections acquired heterosexually reduced by half over the last ten years, from 3400 to 1940 between 2009 and 2018.  Significant declines were reported among London residents between individuals aged 15 and 34 years (Public Health England 2019). The decline was also evident among black Africans and those conceived abroad.  Approximately half of those diagnosed with HIV infections in UK in 2018 were conceived in countries whose HIV infection prevalence is high.  From this resource, I learned that HIV new infections are declining in the UK among heterosexuals, gay and bisexual men, and black Africans. However, I should be concerned about patients from countries with high HIV prevalence because of their likelihood of being infected with HIV.

As a nursing student, I also learned that the UK has recorded a decline in late diagnosis and undiagnosed HIV infections. In 2018, approximately 7,500 individuals in the UK had undiagnosed HIV infection. Public Health England (2019) notes that undiagnosed HIV infection among GBM has reduced by half since 2014 to 3,600 in 2018. The number is also declining among heterosexual black Africans. The existing statistics indicate that the number of individuals being diagnosed late declined to 1883 in 2018 from 3,353 in 2009(Public Health England 2019). However, 2018 continued to record high number of individuals reporting late diagnosis at 43%.  The rate of late diagnosis varied across the population. For instance, Black African Men (65%) had the highest record of late diagnosis, followed by 59% of white men acquiring HIV heterosexually, 59% of individuals aged above 50 years, and 58% of those who inject themselves with drugs (Public Health England 2019). As a student nurse, I learned the need to educate these population segments about HIV testing and early treatment to prolong life. 

 I also learned that the declining HIV prevalence is attributable to the UK’s investment in TasP (Treatment as Prevention) and quality clinical care. For instance, the country in 2018 superseded the UNAIDS 90:90:90 targets.   At the time, about 103,800 individuals were living with HIV. Out of this population, 93% were diagnosed with HIV and 97% were receiving their treatment regimen, and 97% were virally suppressed because of the treatment.  Those accessing HIV care had 97% treatment coverage in 2018(Public Health England 2019).  Apart from those not connected to any form of care, 78% of HIV new cases commenced their treatment three months after diagnoses in 2018. The percentage was higher than in 2015 when it stood at 53%.  Similarly, HIV care retention rate is high at 98 %( Public Health England 2019).  Adherence to treatment regimen has contributed to the declining trend of HIV prevalence in the UK.

 I also learned that the UK has invested in HIV non-specialist and specialist sexual health services (SHS). In 2018, the sexual health services tested more than 1.1millions attendees, a 6 % increase from 2017(Public Health England 2019). With the declining new HIV infection rates, the positivity rate has also declined.  For example, the positivity rate declined to 0.1% in 2018 from o.2% in 2017. The positivity rate also declined among black African heterosexual women and men and stood at 0.4 and 0.3% respectively. Positivity rate also declined among heterosexual women and men, and stood at 0.1% in 2018. GBM have also witnessed a steady decline in test positivity, standing at 0.7%. From these findings, I learned as a nursing student that HIV is no longer a public health challenge because of the declining disease prevalence in the country. People can easily access treatment and testing services regardless of their ethnic backgrounds. 

 Additionally, BHIVA (2018) has designed Standards to enhance the clinical outcomes of those living with HIV.  The standards inform the target population about their disease-related well-being, support, social care, and healthcare standards. The standards also outline service providers across the United Kingdom dedicated to providing people living with HIV the required services.  The Standards also informs individuals living with HIV about commissioners who commissions social care and health for their population segment.  Thus, the standards ensure that people who have HIV have access to the needed services and social support.

 In summary, the learning experience made significant impact on me because it highlighted the milestones achieved by UK in reducing HIV prevalence. For instance, the country has enhanced individuals’ access to treatment and testing services. There are also standards to enhance the clinical outcomes of those diagnosed with HIV.  Initially, I did not understand about the initiatives taken by the UK to manage and prevent HIV.  However, after finishing the learning experience, my values, opinions, and decisions about the country have changed. I have realized that the UK government is doing everything in its power to reduce HIV infections and the number of individuals that remain undiagnosed. Thus, the learning experience has created an interest in me to implement government initiatives to combat HIV prevalence and its impact on the UK population.

Step 3: Now What? 

Task: Describe your next steps – what do you want to do with this new knowledge, where might it take you?  (approx. 350 words). 

From my learning experience, I have learned that HIV treatment has advanced. Therefore, people adhering to their treatment regimen have suppressed viral load and are less likely to transmit HIV. Despite advancements in HIV treatment, people living with HIV continue to face discrimination, isolation, and stress. Nonetheless, the UK government has ensured that every person, including minority groups, have access to testing services and HIV treatment. The government efforts have resulted in the decline of new infections and the number of undiagnosed individuals.  Therefore, addressing misconceptions and negative attitude about HIV requires the UK government in partnership with healthcare providers to ensure that BASH (The British Association for Sexual Health and HIV) objectives are met. They include:

• Promoting, encouraging, and improving the practice and study of managing, treating, and diagnosing HIV, sexually transmitted infections,  and other sexual health issues
• Innovating and delivering  tailored and excellent training and education to trainees, trainers, and healthcare professionals in the UK to tackle the misconceptions about HIV and enhance knowledge on its management
• promoting and championing  safe sexual health and educating the public about HIV
• Determining, monitoring, and maintaining standards of governance in health care and sexual health provision.

Other approaches to increasing awareness about HIV and issues surrounding it include directing those affected and their loved ones to websites like Terrence Higgins Trust(https://www.tht.org.uk/hiv-and-sexual-health) and the National Aids Trust(https://www.nat.org.uk/). These resources have information about sexually transmitted infections, HIV, and strategies to maintaining good sexual health. The websites also provide resources for individuals newly diagnosed with HIV and those living with the disease. Therefore, I will apply what I have learned to create awareness about government resources available to people living with HIV and the need for individuals to get tested and seek treatment early.  

If I could do this task again, I will also focus on factors contributing to new HIV infections in the UK and how the government is collaborating with significant stakeholders to suppress HIV in the population. My efforts in completing this task will contribute to my career because I will provide my patients with facts about HIV, inform them about resources available to enhance their health and well-being, and emphasize the need to adhere to treatment to suppress their viral load and avoid infecting others.