The first cases of severe immune deterioration were recognized in 1981 which developed unusual infections. These infections were later called AIDS (Acquired Immune Deficiency System). It was soon realized that AIDS were caused by HIV (Human Immunodeficiency Virus). Once a person has HIV and the HIV infection progresses, it weakens that person’s ability to fight off other diseases. Once it attacks the immune system, the virus will leave them more susceptible to other diseases. If this person with HIV contracts an additional disease, or once this person’s immune system shows deterioration that is when the person is known to have AIDS. AIDS continues to deteriorate the immune system and this will decrease the body’s ability to fight infections. Hundreds of people become infected with HIV and this causes AIDS which is one of the most serious, deadly diseases in human history and the affects, causes, transmissions and social implications of both HIV and AIDS will be explained in further detail in this essay.

Over the years, more information about HIV works has been learnt, and drugs were developed to interfere and slow down the growth of HIV. These drugs have helped people with the disease because they can now live much longer. But unfortunately there is still no cure for HIV and AIDS. Many people become affected with HIV each year, whether it is teens or adults. HIV can be transmitted from an infected person to another through blood (sharing needles- whether for sharing drugs, injecting steroids or used for tattooing), semen, vaginal fluids (unprotected intercourse) and breast milk. A new born baby can catch the virus from the mother; before birth, during birth or from breastfeeding. If the mother is tested and approaches the doctor before having the child, the doctor can prevent the spread of the virus from the pregnant mother to the expected baby.

Our body contains T-helper lymphocyte cells which contain CD4 receptor sites. These cells help the immune system function normally and they fight off certain kinds of infections. They fight off these infections by acting as messengers to other types of immune system cells, giving them a message to become more active and fight against invading germs. HIV has a core of genetic material, just like other viruses and this genetic material is RNA (ribonucleic acid) and this contains the information that the virus needs in order to replicate. The RNA in HIV has proteins called “reverse transcriptase” which is crucial for replication inside T-helper cells. They also contain proteins called antigens and they have diverse functions in viral replication. These antigens are like hooks on the outside of the virus, and they make it easier for the virus to hook onto the T-helper cells and infect them.

HIV affects the immune system by targeting these T-helper lymphocyte cells and attaches itself to the cells, infects them and uses them as a place to replicate the virus (however they also infect other cells in the body, macrophages, B cells and monocytes). The T cells contain genetic material in the form of DNA (deoxyribonucleic acid) and this is the cell stored all the information is needs in order to function. The CD4 receptor sites are on the surface of the T-helper lymphocyte cells and the HIV antigens fit perfectly in the CDR receptor sites. And once the HIV bumps into the right place on the T-helper cells, the virus immediately locks onto the CD4 receptor site and then it injects its lymphocytes core with the viral RNA and the reverse transcriptase.

In order for the T-helper cell to get infected, the viral RNA must travel to the cell’s nucleus. But before this takes place, an important transformation must occur in the cell. The viral RNA must transform into DNA enable to start the replication process, and this is done by the reverse transcriptase, which borrows material from the cell and changes the codes of the T-helper cell by giving it new DNA codes. Once the viral RNA is transformed to viral DNA, it enters the cell’s nucleus and attaches itself to the T-helpers lymphocytes DNA.  With the virus doing this it destroys the T-helpers function to fight off invading germs in the immune system and new viruses are produced to infect more T-helpers. HIV quickly takes over the body as nearly one billion T-helper lymphocyte cells become infected a day. With the T-helper cell population rapidly decreasing, the body loses its ability to build up an immune response against infections.

With HIV’s capability of reversing the natural process that takes place in cells, by transforming RNA into DNA it is considered to be a retrovirus.HIV belongs to a subgroup of retroviruses known as “slow” viruses, where it takes the virus up to 12 years or more from the initial infection for the virus to begin to show serious symptoms. Once these symptoms begin to show, they get serious infections that they normally would not and become immune deficient and this is called AIDS. Because the immune systems are weakened, people who have AIDS are unable to fight off any infections, particularly tuberculosis and other kinds of rare infections in the lungs, the surface covering the brain or the brain (encephalitis). And with people unable to fight off many infections, they will get sicker, especially if they do not take antiviral medications properly and this can lead to an early death. AIDS also affects the immune system it also affects special blood cells and organ cells such as bone marrow, spleen, liver and lymph cells. These cells create antibodies to try and fight against diseases. With the human body having few T-helper lymphocyte cells because of IHV, some cancers that are stimulated by viral illnesses may occur, and there is a chance for people with AIDS to get forms of lymphoma and a rare tumor of blood vessels in the skin called Kaposi’s sarcoma. With AIDS being fatal, it is important for doctor’s to detect an HIV infection as early as possible so that the infected person can take medication to delay getting AIDS.

Initially most of the people who were infected with HIV and AIDS were men, but as it began to spread more women and children caught the disease. There are about 33 million billion in the world living with HIV/AIDS and as the years go by; the number of people with HIV/AIDS continues to increase. This disease is present everywhere in the world, but is more common in Less Economically Developed Countries (LEDC’s) and unfortunately the anti-retroviral drugs that are available to control the symptoms of this disease are too expensive for those in developing countries. But with these people not having enough money for medication to slow down the growth of HIV and there is no cure and lacking in knowledge about HIV/AIDS, they continue to have unprotected sex and pass on the disease. But there were programs that promoted safe sex practices, and these led to a reduction in HIV/AIDS in these places. It is said that the programs that Thailand held has saved more than 200,000 people from encountering the disease since 1993. With HIV and AIDS being the most deadly disease out there, it is necessary for those with the education to warn young teens and those in developing countries about how anyone can get infected by having unprotected sex and sharing needles. With programs like these it is also helpful for them to give their audience free condoms so that they can practice safe sex and prevent getting such a nasty virus.

Economic impacts :

Economic Impact in Africa

One way in which HIV and AIDS affect the economy is by reducing the labour supply through increased mortality and illness. Amongst those who are able to work, productivity is likely to decline as a result of HIV-related illness. Government income also declines, as tax revenues fall and governments are pressured to increase their spending to deal with the expanding HIV epidemic.

By making labour more expensive and reducing profits, AIDS limits the ability of African countries to attract industries that depend on low-cost labour and makes investments in African businesses less desirable. HIV and AIDS therefore threaten the foundations of economic development in Africa.

The impact that AIDS has had on the economies of African countries is difficult to measure. The economies of the worst affected countries were already struggling with development challenges, debt and declining trade before the epidemic started to affect the continent. AIDS has combined with these factors to further aggravate the situation. It is thought that the yearly impact of AIDS on sub-Saharan Africa’s gross domestic product (GDP) is a loss of 1%. While this is a relatively modest effect, it will build in significance over time, especially in countries where HIV prevalence is rising.

One way in which this impact can be reduced is through the provision of antiretroviral drugs to people living with HIV. A recent study in South Africa suggested that if ARV coverage expanded to reach 50% of those in need of the drugs then the effect of the epidemic on economic growth would be reduced by 17%.

The Impact on Life Expectancy:

In many countries of sub-Saharan Africa, AIDS is erasing decades of progress in extending life expectancy. A recent study found that the average life expectancy of individuals living in sub-Saharan Africa has fallen by five years since the early 1990s, mainly because of AIDS.35 In Swaziland it has been estimated that life expectancy at birth, which is currently just 33, would be 66 without AIDS.

The impact that AIDS has had on average life expectancy is partly attributed to child mortality, as increasing numbers of babies are born with HIV infections acquired from their mothers. The biggest increase in deaths, however, has been among adults aged between 20 and 49 years. This group now accounts for 60% of all deaths in sub-Saharan Africa, compared to 20% between 1985 and 1990, when the epidemic was in its early stages.38 By affecting this age group so heavily, AIDS is hitting adults in their most economically productive years and removing the very people who could be responding to the crisis.

Social Impacts:

The Impact on Households

The toll of HIV and AIDS on households can be very severe. Although no part of the population is unaffected by HIV, it is often the poorest sectors of society that are most vulnerable to the epidemic and for whom the consequences are most severe. In many cases, the presence of AIDS causes the household to dissolve, as parents die and children are sent to relatives for care and upbringing. A study in rural South Africa suggested that households in which an adult had died from AIDS were four times more likely to dissolve than those in which no deaths had occurred.8 Much happens before this dissolution takes place: AIDS strips families of their assets and income earners, further impoverishing the poor.

AIDS in UK:

HIV/AIDs is one of the most deathly diseases in the United Kingdom today. The North-West of The United Kingdom is particularly badly affected. Since the virus was discovered in the 1980s, over 23,000 people have died from AIDs alone. It is estimated that there are around 73,000 people living with HIV in the United Kingdom today. That’s a 1:1000 figure. Although this is not as high as say, Sub-Saharan Africa, it’s still a shocking figure for an MEDC.[1] This shocking amount can be divided into three significant groups – homosexuals, drug users and people receiving blood transfusions, mainly haemophiliacs.

Homosexual relations are estimated to have left 39,000 people currently with the virus. Drug users are over 5,000 of the people with the virus, and blood transfusion patients make up just under 2,000 people living with the virus. The remaining amount of people living with the virus are children who inherited it from their parents, heterosexuals and people who got the virus due to wound contact when kissing/practising first aid etc.

The fact that there are so many people in the United Kingdom living with the virus has put a great strain on the NHS (National Health Service) in the UK. Although people see an MEDC such as The United Kingdom being able to cope well with a disease such as this, the truth is that it is extremely difficult – however, this is for different reasons than in an LEDC.

One of the main problems is that people do not like to come forward for testing. Whereas in an LEDC, the HIV/AIDs virus is so common that it is not considered a taboo, or dirty, in an MEDC, having the virus is considered dirty and foul, and people are afraid of being tested, simply because they know the social impact that it will have on their lives. Socially, the consequences of HIV/AIDs in an MEDC such as the United Kingdom are far greater than in an LEDC. As stated before, people living with the virus know that they will be abused verbally and physically, and that they will be considered infected and dirty. As the disease used to be associated mainly with homosexuals, drug users and sex workers, you can only imagine the horrific abuse HIV/AIDs patients may suffer, even if the abuse is (as is often the case) incorrect.

Another problem that the NHS has, coping with HIV/AIDs patients is not the limited amount of drugs – as would be the case in an LEDC, but the expense and abundance of drugs. The problem is that after a while, an HIV/AIDs patient often becomes resistant to the given drugs. This means that the NHS needs to find a new drug for the patient, one that they are not resistant to. Then extra drugs need to be given to counterbalance the negative side-effects of drugs, such as nausea, vomiting, dizziness and loss of consciousness. This, in effect, means that any one individual may be taking up to twenty pills a day, in a cocktail of chemicals. It’s not the lack of drugs that causes problems in MEDCs, it’s the fact that we constantly have to develop new ones to fight the disease, and this puts a great strain on the economy of a country. In 2005, the United Kingdom spent £23 billion on its health budget. 65% of that went into HIV/AIDs health care, drug development and advertising campaigns, encouraging people to be tested and treated against the virus.

Another economic problem with HIV/AIDs in the United Kingdom is that one of the groups who have the virus is refugees, and they cannot afford drug treatment. Now, as with LEDCs, the United Kingdom, as an MEDC is starting to face the same problem. It cannot afford to supply free drugs to everyone with the virus, and this means that while the middle-class population can afford drug treatment, many working-class people and immigrants cannot.

Campaigns such as Children in Need, Stop AIDs Now and (RED) are working to produce funding for these people, and so far they have raised enough money to keep these people on drug treatment programs.

Demographically, the impact that the HIV virus has had on the United Kingdom is not as great as it is in an LEDC, as you can see when you compare the population pyramids. Still, it does have a definite impact on the amount of deaths and the population in the United Kingdom. You can see that the band of 20-29 year old in the United Kingdom – mainly the children who would have contracted HIV/AIDs in the 80s and 90s is significantly smaller than the bands above and below it. As a result of this, you can foreshadow a drop in an elderly population for the United Kingdom, as well as fewer children, as many HIV/AIDs patients do not wish to have children out of concern of them contracting the virus. There are, however, now ways of preserving sperm, such as ‘sperm washing’ that can ensure children that are given birth to are not contaminated with the virus.

Culture is one of the most important determining factors in healthcare preferences and practices. Thus, the need for transcultural nursing is undeniable. “Transcultural nursing requires sophisticated assessment and analytic skills and the ability to plan, design, implement, and evaluate nursing care for individuals, families, groups, and communities representing various cultures” (Andrews and Boyle, 2008, p.4). In order to effectively practice transcultural nursing, one must first understand the need for cultural competence. It is vital for nurses to have a desire to become culturally aware, culturally knowledgeable, culturally skillful, and to seek cultural encounters. Cultural desire is the stimulator in the eruption of the process of cultural competence and the nurse must seek and be open to learn and accept others, understand the process is lifelong, and set aside personal feelings to effectively treat unique patients (Campinha-Bacote, J, 2003). The Giger and Davidhizar (2002) Transcultural Model is a helpful tool that addresses and effectively treats patients who have different cultures. The model takes into consideration 6 important phenomena.

Communication keeps culture alive by verbal and nonverbal means; it is one of the biggest obstacles in healthcare. Nurses ask questions to determine patient’s views on illness, causes, and possible treatments. They listen and interpret their patient’s level of understanding and ability to follow through with treatment. Also, nurses interact with the patient’s family. Communication varies from culture to culture. Americans are expected to speak Standard English; however, it varies based on region, ethnicity, and social class (United States, 2001). Americans use a variety of nonverbal communication. Eye contact, which is viewed as a sign of trust and honesty, between patients and healthcare professionals is the norm. Expression of emotion varies in American culture. Americans use a combination of verbal language, body language, and gestures. Americans are often straightforward and rather demanding. Unlike Americans, Asians rarely complain. Silence and withdrawal may be the only indication of a problem. Asians tend to not ask for anything, accept pain, and remain stoic (Fernandez V. & K., 2008, Asian Community). Many Asians don’t engage in eye contact with powerful persons; the avoidance of eye contact shows respect and reverence (Non-Verbal Communication, p.4). Asians speak more than 100 languages; they vary based on the geographic regions they descend from (Asian Americans, p. 2). Arab Muslims usually cooperate by answering questions, listening, and following directions until they see improvement. They believe their expression, such as pain, should be quickly met with response (Fernandez V. & K., 2008, The Middle Eastern Community). The Arabic language uses devices that outmatch reality and is not very direct or explicit (Ayish, 2003). Hispanics are very emotionally expressive. Effective communication with Hispanics is not based on just speaking their language; cultural rules allow for certain discussions with certain people (Fernandez V. & K., 2008, The Hispanic American Community). Eye contact is expected on the nurse’s part but will not necessarily be reciprocated (Andrews & Boyle, p.25). Nurses, if available, should undergo cultural competency training. Berln and Fowkes’ LEARN Model can assist; LEARN, represents the process of listening to the patient, explaining your view, acknowledging differences and similarities, recommending and negotiating a plan (Campinha-Bacote, J.,2003). Nurses should enlist the help of trained interpreters, preferably of the same gender, mature, and of no relation to patient; if there is no interpreter, the following but not limited to, is necessary: politeness, slow and concise speaking, simplicity, pantomime, validation of understanding, and instructions in the proper sequence (Andrews & Boyle, p.29).

Space is also important when dealing with various cultures. Nurses are required to interact with patients, often invading personal space. Giger and Davidhizar (2002) state:

Territoriality refers to feelings or an attitude toward one’s personal area. Each person has their own territorial behavior. Feelings of territoriality or violation of the client’s personal and intimate space can cause discomfort and may result in a client’s refusing treatment or not returning for further care. (p. 185)

Americans tend to require a need for personal space. When family and friends are near, Americans tend to be relaxed; however, when a stranger or mere acquaintance invades space, it can become uncomfortable. Asians prefer a great amount of social distance. Many prefer minimum physical contact with acquaintances; excessive contact is viewed as inappropriate. Unlike Americans, who believe touch is a sign of friendliness, Asians view the head as a personal area that contains the seat of the soul and it should not be touched. Arab Muslims seem to require the least amount of space. It is not uncommon for people from the Middle East to stand closely when conversing. However, gender can play a role; Muslim woman may become distraught when a male, even a healthcare professional, stands or sits near her; Arab Muslims expect females to tend to females and males will care for males. Hispanics, unlike Americans, are use to standing or sitting near people they are not well acquainted with (Non-Verbal Communication, p.3). Hispanics and Arab Muslims may unintentionally invade nurse’s space as a means of getting closer and more comfortable (Andrews & Boyle, p.26). Nurses should take the patient’s lead; if the patient seems to gravitate towards you or initiates touch, then it is acceptable to do the same. At all times respect the patient and boundaries.

When dealing with patients, there must be consideration of social organizations or what role the patient’s culture plays in his or her life. Family members are often the providers of a patient’s eating habits, sick role behaviors, and medications used. Americans view family as a vital part of their healthcare plans. It is common for Americans to be visited and supported by family; they often discuss and make important decisions. Asians are concerned with family interdependence over independence; family usually likes to assist with patient care. In some Asian cultures, some members, such as men and elders, dominate and consider women and children inferior (Galanti, 2005). Arab Muslims regard family as the foundation of their society. The husband answers questions, makes all major decisions, and gives consent. Often times, Arab Muslims don’t believe in divulging family history. The family cares for the ill. (The Middle Eastern Community). Hispanics have large families who visit for long hours as a way to demonstrate their love and genuine concern. Often times, decisions are made by the entire family or designated members (Galanti, 2003). Religious and spiritual beliefs are important factors during illness, recovery, and death. In the United States, most people consider themselves Christians; Catholics singly dominate, but the Protestant groups combined outnumber them. Americans include religious practitioners such as priest, ministers, and rabbis as well as nontraditional leaders during health related situations. Americans include religious objects, such as the Bible, and also rituals, such as communion. Death and end of life choices are also influenced by religion and practices; typically, Americans consider death a sad and somber time. Asians are host to numerous religions; Christian, Muslim, Buddhism, and Hindu are just a few. Many Asians believe in bad spirits; infants attract them and induce death. If the illness is thought to be caused by spirits, healers are sought (Asian Community). Arab Muslims are usually of the Islamic faith and pray 5 times a day to the Holy Land, Mecca. Muslims recharge their spiritual battery during the month of Ramadan; fasting from dawn to sunset accompanies. Arab Muslims often read from the Al Quran (The Middle Eastern Community). Hispanics are usually Catholics with the recent emergence of Pentecostals. Shrines and religious objects are common in practice. Health is viewed as God’s gift and should be revered (The Hispanic Community). Nurses must be accommodating to patient’s families and the value placed on family within cultures. Nurses must be sensitive to religious beliefs or practices and must not impose personal beliefs. Seeking knowledge is essential. However, exposure to diverse cultures is one the best learning mechanisms.

Understanding a cultures notion of time elapsing, specific periods, and clock time are

necessary for effective healthcare. Cultures may be past, present, or future oriented. Americans use time to provide order. Americans expect care at designated times; appointments are a prime example. Americans are future oriented; they believe they can manipulate the future by taking certain actions. Americans tend to be proactive; the focus is optimism, coping strategies, and preventive measures. Americans often demonstrate this orientation through self examinations, check-ups, and staying informed about healthcare advances. Asians tend to have a past orientation. They prefer to adhere to traditional methods and treatments; they are apprehensive about new innovations. Recently however, Asians are shifting towards future orientation (Galanti, 2004). Arab Muslims are present oriented and are neglectful of preventive measures. They may be late or not attend appointments at all (The Middle Eastern Community). Hispanics also focus on the present. They believe the future arrives in its own time and thus the notion that one cannot be late exist (Galanti, 2004). Nurses must explain the importance of time regarding life processes while being respectful and mindful of cultural views. Nurses should try to refrain from making time oriented promises that can’t be kept.

Environmental control or the attempt to control nature affects patient’s health practices, values, and the definitions of health and illness (Giger, & Davidhizar, 2002). Americans believe nature can be controlled. Americans equate the body to a machine; if it’s broken, allow healthcare professionals to fix it (Galanti, 2004). Americans conform to the Western biomedical model which defines health as the absence of disease or the signs and symptoms of disease. The holistic paradigm exists in Asian cultures; it deals with the concept of yin and yang, in which forces of nature must be balanced to produce harmony (Andrew & Boyles, 69). Asians tend to view people as part of nature. The land is a resource used to treat disease; herbal remedies are common (Galanti, 2004). Arabs believe the key to good health is personal hygiene and a healthy diet. “They place a high value in modern Western medicine and have confidence in the medical profession” (The Middle Eastern Community). Hispanics believe natural forces are not in their control and preventative measures are not often taken. (Galanti, 2004). Their system, the Curanderismo, combines spiritualistic, homeopathic, and scientific elements; curandero or holistic healers are utilized (The Hispanic Community). Nurses should become familiar with factors. Nurses should not dismiss patient’s view of their power and accountability or lack thereof.

Biological variations exist between races; some groups are sensitive to certain medications, have metabolic differences, and are prone to certain diseases or factors that can affect healthcare. African Americans are three times more likely to get tuberculosis than whites; they also have higher rates of hypertension. Sensitivity to cardiovascular effects from Propranolol occurs more in Asians than Whites. Ethnic minorities, such as Hispanics, have higher HIV rates (Giger and Davidhizar, 2002). Middle Easterners or Arab Muslims have a lower percentage of sweat chlorides (Andrews & Boyle, 54). The list of variations is broad and extensive. “Accurate assessment and evaluation of clients require knowledge of normal biocultural variations among healthy members of selected populations” (Andrews & Boyles, 49). Nurses must acquire skills that will allow the recognition of variations.

A nurse must always remember that the focus should remain on the patient’s well being and recovery. It is necessary to understand that individuals will never be the same. A patient’s health status and treatment is directly influenced by their culture and it is this reasoning, which has been proven through testing and the development of theories that has led to the conclusion that culture cannot and will not be ignored. “Human diversity makes tolerance more than a virtue; it makes it a requirement for survival” (Dubos). Healthcare will not suffice without negotiation, adjustment, and respect of differences. Transcutlural concepts in nursing care have made cultural competency an expected standard and it is the duty of every nurse to help maintain this standard.