“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2003). Health can be disturbed by disease. People suffer from variety of disease, which not only affect our physical health but also mental health. Considering the significant feature of AIDS is a disease which affects one’s individual life along with society. AIDS is the epidemic diseases affecting both industrialized and developing countries and morbidity and mortality rates of AIDS are gradually increasing. In south East Asia prevalence of AIDS in 2007 was 0.35% and progressively increasing in other countries of south Asia. Pakistan is at high risk for HIV/AIDs epidemic due to several socioeconomic conditions, including illiteracy, unemployment and poverty.

Furthermore, Pakistan is identified as a low-prevalence, high-risk country for HIV infection. General population prevalence was estimated as 0.1% and high-risk population prevalence as 1-2% (UNAIDS). 96,000 people living with HIV/AIDS in Pakistan, and 5,100 people died of AIDS-related complications. In developing countries around 90% people are suffering from AIDS and incidence rate is provoked by illiteracy, unhealthy sexual practices, lack of medical facilities, use of contaminated syringes and drug injectors (Yousaf, Zia, Babar & Ashraf, 2011). Sex workers and drug injectors are highly vulnerable to HIV due to inadequate knowledge which leads to HIV infection (UNAIDS, 2006). Common transmission of HIV/AIDS is mainly heterosexual is 52.55%, contaminated blood products is 11.73%. Other includes IDU-injecting drug users 2.02%, male-to-male or bisexual relations 4.55%, mother-to-child transmission 2.2% and transmission of undetermined origin 26.9 %. (Bhurgri, 2006).

AIDS is fourth major cause of death. Globally, in December 2007 people living with AIDS were 33.2 million thus morbidity rate was 2.5 million and mortality was 2.1 million (Park, 2009). Likewise, worldwide 16 million people inject drugs and among them 3 million are having HIV. On average, one out of every ten new HIV infections is affected by injecting drug users and in some countries like Eastern Europe and Central Asia over 80 % of all HIV infections is related to drug users. A survey conducted in Lahore and Karachi (March-July 2004) indicated an epidemic of HIV positive among injecting drug users (IDUs) which is 23% out of 402 and man sex with mans which is 4% out of 409 in Karachi (world bank,2006). HIV/AIDS Surveillance Report, Pakistan 2006-07 sexual activities between commercial workers like, FSWs, MSWs, HSWs and IDUs will increase the epidemic potential. In Pakistan, although HIV infection rates among FSWs remain very low, there is evidence of sexual interaction between FSWs and IDUs. Approximately 2.3% of FSWs and 5.7% of MSW and HSWs reported that they are also IDUs (Zaheer et al., 2008). In AKUH 36 cases of AIDS were identified among people of age group of 18-40 years in last six years.

HIV/AIDS was first discovery in 1983 and pathogen involved in the cause of AIDS was HIV-1. Later on in 1986, a second type of virus was discovered HIV-2, which was isolated from HIV patient. Simian immunodeficiency virus (SIV) is originated naturally in a monkey of West African (Sharp & Hahn, 2010). Studies shows the close relation of primary human immunodeficiency virus (HIV-1) and simian immunodeficiency virus which carried by chimpanzee. After comparison, investigators concluded that there must be multiple transmission events from simians to humans (Moore, 2004). In Pakistan, AIDS was firstly detected in 1987 in Lahore. In late 1980s and 1990s, incidences were increased. Generally men were infected while living in or move to abroad and transmit infection to their spouse and it may pass to their children. In 1993, transmission of AIDS through breast feeding was firstly reported in Rawalpindi. During 1990s, HIV/AIDS cases start to appear among commercial sex workers, drug abusers and jail prisoners. During the time period of 2005 to 2007 HIV cases increased from 9% to 15.8% in drug users and more than 6000 cases were reported till 2010 (Ilyas et al., 2001).

Pakistan is a low socioeconomic country with increase in population and unemployment which brings it to a high risk for HIV due to a progressive increase in urbanization and immigration. People live unaccompanied in abroad they try to satisfy their sexual desires by prostitution or engaging in homosexual behaviors. Similarly factors like political instability, War on terror and frequent natural disasters provoke an individual to use drugs as coping mechanism. Research in Pakistan a special Issue of JPMA on HIV/AIDS highlights that commercial sex worker, male transvestites, homosexual men, long distance truckers, sailors, needle sharers, prisoners, deployed army troops and unscreened blood products recipients are high risk group in Pakistan. AIDS in gays and Hijras (homosexuality) being highly stigmatized and religious taboo which are under-reported, so mostly uncovered in various projects on HIV (Altaf, Abbas & Zaheer, 2008).Consequently, condom use is very low (6.7%) among male sex workers and Hijra sex workers (Ahmed et al., 2003). Risk behaviors include sharing of syringes, lack of awareness about blood born infections and due to financial issues or using inject-able drugs prone them to vulnerability. High risk groups can be explained by necessary and sufficient causes. Sufficient causes for HIV transmission comprises of Human Immune Deficiency Virus, which must be present in sufficient quantity and should enter to blood stream. In infectious disease presence of pathogen is necessary. In HIV only one risky behavior like anal intercourse cannot cause HIV infection. Likewise, amount of virus in body fluids determines whether infection has been transferred or not (Card et al., 2008). HIV is present in saliva, sweat, tears, and urine in low amount and in anal secretion virus present moderate amount. While, higher concentration is found in blood and vaginal secretions. Small amount of infected blood, breast milk or semen is enough to get infection. Thus there are multiple causes and risk factors for HIV/AIDS but only HIV virus is necessary cause and other factors like risky behavior consider as sufficient. HIV can be explained from epidemiological triad in which HIV is agent responsible for infection. Nonliving agents include drugs and contaminated syringes. Human being is the host which also includes its characteristics; for instance, sex and life style. Female is at higher risk and those who are living alone and far away from family. Last component of triad includes environmental factors and geographical location also increases risk. Pakistan is sharing border with Afghanistan a country having free trade of drugs. Similarly, social components also determinant increase risk for HIV. Customs like late marriages, practices of premature sex, lack of sex education etc.

In addition, Natural process of diseases is divided into three phases; primary phase, secondary phase and tertiary phase. In primary phase nonspecific symptoms appear. However, in secondary phase is the clinical latency period up to ten years and AIDS become clinically apparent in tertiary phase (Yadav & Sinha, 2006). Clinical progression of AIDS is divided into seven stages. In First stage pathogen enters in the body through infected blood, unsafe sexual behaviors, prenatal transmission (placenta to fetus), and through breast feeding. Second stage is also known as acute/primary HIV infection or acute Seroconversion syndrome. Infection begins from the time of exposure to the appearance of the first sign and symptoms which called as incubation period. It comprises of 2 to 4 weeks but it may exceed to 6 weeks. AIDS is difficult to diagnose because of vague sign and symptoms. Classical sign and symptoms at this stage include lymphadenopathy, fever, rashes, sore throat myalgia and arthralgia. Two diagnostic test HIV RNA and p24 antigen are performed to identify the presence of diseases. The third stage is Seroconversion in which infected individual will be HIV positive and it can be detected by laboratory test. Seroconversion is also called as window period which lies between six months to 10 years. In fourth stage the T helpers cells are reduce in considerable amount it is known as early HIV diseases. Fifth stage is asymptomatic infection in which diseases progress by high level of destruction of T-helper cells. Sixth stage is early symptomatic HIV infection in which sign and symptoms becomes more apparent and severe which are peripheral neuropathy, vaginal candidiasis, leukoplakia and cervical dysplasia. AIDS and advanced HIV infections are the last stages where the CD4 count becomes less than 200cells/mm3 and 50cells/mm3 respectively. In last stages immune gets suppressed and body will be susceptible to multiple diseases like TB, cancers, neurological and infectious diseases, ultimately lead to death within 12 to 18 months (Sankaran, Volkwein & Bonsall, 1999).

Moreover, National AIDS control programme of Pakistan recommends the major focus on reducing HIV infection among high risk population. The primordial and primary preventive measures for HIV/AIDS, awareness programs through media, religious leaders, health workers to general population by providing teaching on not to share contaminated syringes, using sterile equipment and avoid unsafe sexual practices. Through health promotion it will increases the awareness among individuals and providing specific protection to the risk groups such as IDUs, FSWs, MSMs, HSWs. AIDS among drug injectors are increased in Pakistan because of low level of awareness and non effective rules against the drug users (Ahmed et al.,2003). The appropriate legislation or banning on usage of drugs and its import from neighboring country would be effective strategy. Study further suggests blood transfusion is a risk factor; the primary preventive measure for this could be prohibiting the paid blood donations and promoting screening of blood before transfusion. Financial empowerment of drug users will assist them in returning to the society through provision of occupational skills training and job opportunity. Secondary prevention includes early detection of HIV, so high risk population should be screened for level of p24 antigen and CD4 level in blood, which is raised in primary infection stage. To prevent it from further deterioration provide adequate treatment which comprise of retroviral therapy. According to Lancet (2004) Retroviral therapy is the only supportive treatments for HIV and it helps to suppress the infection. Combination antiretroviral therapies (cART) have significantly improved the life expectancy of HIV infected individual and prevent infections. Secondary prevention will be need between the pathological onset and disease symptoms in the window period. It will decrease the prevalence by reducing the onset of diseases (Ann et al., 2008). Tertiary prevention will help patient to prevent any disabilities and opportunistic bacterial and viral infections in clinical or AIDS stage. Hence, lesser life threatening infections will increase their quality of life. In terminal stage only palliative care is important to avoid disabilities because it suppresses immune system.

In addition, primary health care infrastructure needs to be strengthened to provide better access to AIDS education and counseling. These measures include adequate hospital facilities to deal with the epidemic of AIDS (Semba & Bloem, 2008). Health care professional promotes public health by safe practices e.g. wearing gloves during procedure. Along with patients, staff should also take preventive measures. Pakistani government can play their role by establishment of HIV health care centers or Study center where registry can be done of HIV infected patients, where people can approach for awareness. It will be a supportive step for public education, and reducing stigma against HIV in society.

In conclusion, health comprises of physical, mental and social wellbeing. Various diseases can alter health state. HIV infection is having devastating impact in developing countries. Pakistan is high risk country due to its geographic location, socio-cultural background and Unhealthy sexual practices, lack of medical facilities and illiteracy. IDU’s, FSW, MSW, Arm Forces are high risk population and under-reported. First case in Pakistan was identified in Lahore. In light of web of causation HIV is necessary cause and risky behavior are sufficient causes. AIDS has three phases primary infection phase, secondary latency phase and tertiary phases. In last stage CD4 cell count lessened and patient get susceptible to other diseases. Primary focus is to aware about AIDS high risk population. Secondary level includes screening and ART therapy and tertiary level comprises of preventing spread and managing infections. Center should build for HIV management and program should be run by government for prevention as it is said that prevention is better than cure.

Strategies for Reducing Obesity for the Prevention of Chronic Ilnesses

The rate of speed in which the occurrences of chronic illnesses has increased in the US has provoked a desperate movement amongst millions of individuals to take daily health decisions more seriously. For decades now, the pharmaceutical and medical industries have conducted an all-out effort to promulgate remedies that would target stress, depression, cancers, diabetes and everything else. However, how effective has these so-called remedies been in accomplishing what the medical industry has sought to cure. Well in the case of diabetes, as a nation, we have experienced an approximate 700 percent increase within the last 50 years. The billions of dollars being directed toward Cancer Research has not ameliorated the increase of patients being diagnosed with breast cancer, prostate cancer, colon cancer, etc. Drug addiction, the opioid crisis, depression and suicides have not faded away but have increased to stunningly high proportions. Thus, we can conclude that the pharmaceutical industry has not achieved its primary objective in suppressing the proliferation of chronic illnesses in our country, which is why we must explore other alternatives. As most educated individuals know, a healthy and vigorous lifestyle can be achieved and sustained by eating a wholesome and natural diet, experiencing adequate sleep, a daily exercise regime, and controlling stress. These strategies are crucial for the prevention of chronic illnesses as well as possibly curing some forms of diseases. Diabetes and obesity are the two chronic illnesses that will be discussed in more depth because they’re both amongst the most commonly diagnosed chronic illnesses in our country today. The aim of this study is to provide some background information on these two commonly diagnosed chronic illnesses and discover the impact that this epidemic has had on our health care system. Possible remedies aiming to prevent the onset and outbreak of these two illnesses will also be explored in more detail.

Diabetes is a disease in which glucose in the blood and urine rise to elevated levels due to an impairment of insulin. This often causes an abnormal metabolism within the body and directly leads to excessive thirst and urination, along with rapid weight loss. Diabetes is classified into two separate divisions: Diabetes 1 and Diabetes 2, the latter being the more common form of diabetes, affecting anywhere from 90-95 percent of diabetic patients (cdc.gov, 2018). Some studies reveal that Diabetes 2 impacts the lives of over 29 million people in the United States, and as stated previously, has increased 700 percent within the last 50 years. Diabetes 2 is a form of illness when the body either fails to recognize or produce the hormone insulin (insulin resistance). This impairs proper functioning in the eyes, kidneys, nerves and heart; as well as causing energy levels within the body to plummet. Diabetes is typically treated by taking oral medications like pills and/or insulin to regulate blood glucose levels within the body in addition to partaking in healthy lifestyle changes. Diabetes remains as the seventh leading cause of death in the United States with about 1.6 million deaths being directly caused by diabetes in 2015. Keeping this in mind, it is important to ask why the medical and pharmaceutical industries have not succeeded in decreasing the amount of chronic diseases that flourish in our beloved country, particularly diabetes. Our failures to contain the outbreak of diabetes has provoked a crippling effect on the healthcare system, primarily pertaining to costs, resources, human productivity, etc.

Diabetes is one of the leading causes of death in the United States. Billions of dollars are spent annually to provide diagnostic treatment, prescription medications, hospital inpatient care, therapy, and other basic services to aid millions of ill patients. The estimated total economic cost of diagnosed diabetes in 2017 is $327 billion, a 26% increase from 2012 (diabetes.org, 2018). This illustrates the crippling impact that diabetes has on our healthcare system, requiring new technologies, experienced doctors and nurses, and most significantly, much time and public money. The largest element of medical expenditures for caring for people with diagnosed diabetes is hospital inpatient care, amounting to roughly 30% of the total annual costs for healthcare. Prescription medications is equally debilitating as it also consumes about 30% of total medical costs (diabetes.org, 2018). There are also indirect costs associated with a high number of the population suffering from diabetes, including lost productivity among medical employees and lost productivity among the diseased patients. In 1997, more than $37 billion dollars was lost due to individuals not being capable of working and being productive due to diabetes (diabetes.org, 2017). Furthermore, with a higher prevalence in diabetes in the United States, more public money is required to fund government-sponsored programs like Medicare and Medicare. About two thirds of the medical costs aimed at caring for diabetic patients is funded by Medicare, Medicaid and military programs (diabetes.org, 2017). Thus, diabetes and other chronic illnesses has become a financial burden for society and only time will tell as to whether the medical and pharmaceutical industries can ameliorate the nationwide epidemic.

Obesity is a condition involving an excessive amount of body fat. Too much body fat can have adverse effects on the human body, including an increased risk of high blood pressure, heart disease and other chronic illnesses. Health professionals have a method of identifying obesity within an individual by calculating the body mass index (BMI) of the body. Different methods of measurement are used throughout the world, but in the United States, the body mass index is determined by dividing a person’s weight by the square of the person’s height. Obesity is widespread in the United States, particularly in southern states, as 1 of every 3 adults are classified as suffering from being overweight and/or obese (Flegal, Kruszon, Carroll, etc., 2016). The Center for Disease Control and Prevention has determined that about 93.3 million of U.S adults suffered from obesity in 2015-2016 (cdc.gov, 2018). From 2000 to 2010, the number of Americans dealing with severe obesity has increased by 70 percent (Smith & Hattori, 2012). The causes of obesity among U.S adults and children are lack of physical activity, diets characterized by excess unhealthy fats and high-calorie foods, and on rare occasions, genetic disorders. A healthy diet consisting of whole foods and nutritionally-packed calories, adequate physical activity and sleep are important steps to take to protect from obesity and chronic diseases in general. The prevalence of obesity in the United States has led to a heavy financial and time-consuming burden on the healthcare system, which will be discussed further.

Research conducted by John Cawley, professor of policy analysis and management at Cornell University, demonstrates the impact that obesity has had on costs in the healthcare system. His study focuses on annual reports released by individual states, and shows some remarkable statistics on the extent in which some states are plagued by obesity. “Over 2001-15, Kentucky and Wisconsin devoted over 20 percent of their Medicaid spending to obesity-related illness (Biener, Cawley & Meyerhoefer. 2018).” Other states have also been shown to struggle with the countless number of Medicaid patients dealing with obesity and obesity-related illnesses, states like North Carolina and Ohio for instance. The national average of Medicaid spending being directed toward obesity-related illnesses is 8.23 percent (Biener, Cawley & Meyerhoefer. 2018), according to John Cawley in his research. Based on his findings, income, educational background and access to healthcare has proven to directly correlate with obesity.

Obesity, as a disease has flourished to an exponentially high degree within the past four decades and has had a crippling effect on the healthcare system. Lost productivity, the costs associated with equipment and hospital inpatient care, prescription medication costs, and other costs are the main factors that make obesity so costly for the healthcare system. Further studies conducted by John Cawley demonstrate the remarkable high medical costs associated with severe obesity. According to his extended research, the medical care costs of obese adults is raised by an estimated $3,429 (in 2013 dollars) (Cawley & Meyerhoefer, 2012). This is an increase of 11.7 percent form 2005. The prevalence of obesity in society, the steady increase of medical costs per year, and a growing U.S population are all factors that causes obesity to become an even heavier financial burden. However, though the medical care costs of obesity seem to be plaguing the nation, there is another facet to the issue that slightly neutralizes the costs. With a higher prevalence of obesity, U.S adults are more likely to get diagnosed with other chronic illnesses, thus leading to a shorter life span. The shorter life spans of obese adults reduce the amount of costs paid to diagnosed patients after the age of 85, because obese patients typically do not live as long as healthy individuals. Consequently, less Medicare, Medicaid and other health care benefits are required to suffice for the high number of obese patients’ after a certain age. Some estimates conclude that Medicare enrollees 85 and older spend 2.5 times more on healthcare than those aged 65 to 74 (Cubansk, Swoope, Damico & Neuman, 2014). With the vast majority of obese patients facing mortality before age 85, this serves to offset the high amount of medical care costs that is spent to assist these patients; to a certain extent of course. To conclude, because lower rates of obesity lead to improved health and lower health care spending, there has been substantial effort performed in reducing the fraction of the population that is obese. However, at the same token, patients suffering from obesity have high mortality rates at younger ages, which slightly neutralizes the costs by decreasing the amount of benefits disbursed in later stages of life.

In addition to the costs of funding Medicaid services, Medicare costs are equally as troubling to the American taxpayer and middle class. Medicare services must be provided for individuals, particularly the elderly and mentally and physically-disabled. About 16 percent of individuals that are enrolled in Medicare are also enrolled in Medicaid, so public taxpayer money is required in abundance to compensate for many of these individuals and families seeking services. In 2016, net Medicare spending totaled $588 billion and a decent portion of that was funded by payroll taxes (Angres & Costantino, 2016).  It is estimated that about 38 percent of the Medicare budget is funded by payroll taxes (Angres & Costantino, 2016). Thus, the Medicare programs may be more of a burden on American taxpayers than it is toward the pharmaceutical industry. Nonetheless, a sizable amount of money is required each year from the middle class to compensate for the amount of chronically ill patients in our hospitals. Furthermore, about 20 percent of Medicare enrollees rely on Medicaid benefits to compensate for the services that are not included in Medicare Advantage packages (Angres & Costantino, 2016). Thus, it is in the best interest of all Americans to live healthier lives so that much of our hard-earned wealth can be enjoyed instead of transferred to fund these healthcare programs.

The impact of chronic illnesses on health care expenditures and direct medical costs is remarkably high to say the least. Health care costs for chronic illnesses like cancer, diabetes, heart disease and obesity amounted to over 1 trillion dollars in 2016 (Waters & Graf, 2018). When accounting for other factors like lost economic productivity, the money utilized reaches over 3 times that amount. The chronic illness epidemic influences more aspects of our lives than realized. It not only costs much time and human productivity to be dispensed, but it also raises taxation to high proportions, transfers our hard-earned wealth to fund Medicare and Medicaid programs, consumes the lives of doctors and nurses, requires more equipment and technologies, and keeps people sick and lifeless. Thus, the American people should seek every possible remedy to reduce the number of patients perishing from diabetes, obesity and other chronic illnesses. The best remedies for this crisis include avoiding tobacco and alcohol by all means, or at least aim to minimize the amount of tobacco and alcohol consumed. Also, a healthy diet characterized by wholesome, organic fruits, vegetables and nuts and meats are essential to maintaining a healthy weight and a well-functioning mind. Processed foods, foods laced with preservatives and chemicals, and genetically-modified foods should be avoided by all means necessary. Physical activity at least 2-3 times will certainly work wonders for the body by reducing the level of toxins in the body and stabilizing the body’s systems. Walking, bike riding and running are all activities that strengthen the mind and body much more than driving automobiles. Finally, keeping in touch with your primary health provider can help with detecting the onset of chronic illnesses in the body at an earlier stage. These remedies and much more can cause the prevalence of diabetes and obesity to steadily decline; however, the commitment and determination of individuals is also required in order to accomplish these objectives.

Works Cited

• Adam Biener, John Cawley, Chad Meyerhoefer. The Impact of Obesity on Medical Care Costs and Labor Market Outcomes in the US. Clinical Chemistry, 2018; 64 (1).
• American Diabetes Association. (2018, March 22). The Cost of Diabetes. Retrieved October 26, 2018, from
  
  http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html
  
• American Diabetes Association. Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care. 1998;21(2):296-309.
• Angres, L., & Costantino, M. (2016, September 30). The Federal Budget in 2016: An Infographic. Retrieved from
  
  https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/graphic/52408-budgetoverall.pdf
  
• Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ. 2012;31(1):219–30.
• Center for Disease Control and Prevention. (2018, August 15). Diabetes Home. Retrieved from
  
  https://www.cdc.gov/diabetes/basics/type2.html
  
• Center for Disease Control and Prevention. (2018, August 13). Overweight & Obesity. Retrieved October 26, 2018, from
  
  https://www.cdc.gov/obesity/data/adult.html
  
• Cubansk, J., Swoope, C., Damico, A., & Neuman, T. (2014). How Much Is Enough? Out-of-Pocket Spending Among Medicare Beneficiaries. Kaiser Family Foundation.
• Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. The Journal of the American Medical Association. 2016;315(21):2284–2291.
• Sturm, R., & Hattori, A. (2012). Morbid obesity rates continue to rise rapidly in the United States.
  
  International Journal of Obesity,37
  
  (6), 889-891.
• Waters, H., & Graf, M. (2018). The Cost of Chronic Diseases in the U.S.
  
  Milken Institute
  
  . Retrieved October 26, 2018.