Perspectives on HIV
There are many environmental challenges that face mankind on a daily basis. These challenges can be classified under natural disasters or man induced disasters. Looking at epidemics, one can say that the human species dwells in a world where at one time or the other gets attacked by abnormal environmental conditions.
Abnormal conditions negatively affect some part or the whole body of an organism, preventing it from operating at its maximum potential (Rand, 2013). When an organism experiences abnormal conditions; it is said to be sick, or has a disease.
There are many diseases in the world. Some are curable while others are not. For example, ever since the discovery of HIV/AIDS, no cure has been engineered as of today. However, the disease can be contained under medication, although it is not curable once it has attached itself to an organism. This disease has become of significant concern to public health in the world, more so in areas where it has registered high prevalence rates (Kennedy, 2003). The African continent seems to be more affected by this disease more than any other part of the world. This is more in the sub-Saharan Africa region, although countries outside this region have also continued to register high HIV prevalence rates. South Africa stands as the best example since HIV prevalence rate in this country is as high as 26.7 percent. Statistics show that the African continent is home to only about 15.2 percent of the total world population. However, the Sub-Saharan region of Africa alone accounts for more than 70 % of people living with HIV in the world. On top of that, HIV death statistics gathered in 2007 showed that the region accounted to more than 70 percent of all deaths resulting from HIV infections (Besada, 2009). This case study seeks to address HIV prevalence among other perspectives in the country of Liberia.
Liberia is one of the countries found in the West African region, whose HIV prevalence rate has been rated between average and moderate. However, there are fears that this country has not adopted enough measures of combating the diseases in all level. One of the area where the Liberian government has not adopted effective measures of combating this disease is when it comes to mother to child transmission. Mothers are still transmitting HIV to their newborns at birth and even during suckling. This factor is one of the primary reasons why the Liberian government under my commission is thinking of making HIV tests a mandatory to all pregnant mothers. The first case of HIV in Liberia is believed to have been diagnosed as early as 1986. This was in the north-west Part of this country, in a region called Zorzor in Lofa County (Besada, 2009). As a result, the then Liberian government set up the National Aids and STI Control Programme, under the ministry of health with the hopes of combating the spread of the disease. However, even before this center could be properly setup, the gathered database concerning the disease was destroyed during the hostilities that rocked the country in 2004. However, the National Aids and STI Control Programme have been rebuilt to continue with its initial duties since the country realized peace. The duties of this programme include;
- Provision of quality care to individuals affected and infected by HIV/Aids.
- Preventing HIV infects in the country, more so from mother to child infections.
- Analyzing the impacts and any other form of effects of HIV/AIDS in the country of Liberia.
Recent statistics concerning the disease shows that Liberia has a HIV prevalence rate of about 1.5 percent. This is especially among the population aged between 15 and 49 years of age. These statistics indicate a generalized low-level epidemic that is affecting this country. Other than that, statistics from antenatal sentinel surveillance also revealed that the prevalence rates had dropped. That is from as high as 5.7 percent in 2006 to 4.0 percent is 2008 (Besada, 2009). As result, the Liberian government believes that if more effective measures meant at addressing the disease were adopted, the prevalence rates of HIV in this country could be significantly reduced.
One of these means of curbing the spread is the idea of compulsory HIV testing for all newborns in this country. Therefore, if I were appointed to serve on a national panel to substantiate a recommendation for mandatory HIV testing for every new born in Liberia, I would be for the idea without having a second thought about it. This ideology would be meant to save lives and also decrease the spread of HIV in this country. This reason would be enough for me to support the ideology for it would have many advantages. For starters, looking at the rate of infants being born with the disease in this country, it is alarming to see that the infection rate is as high as 5.7 percent. This is according to the first ante natal survey which was carried out concerning the disease between July and October of 2006 (Besada, 2009). This was the first survey which had been carried out in the country in 15 years. The survey was aimed at determining the HIV infection rate among pregnant women attending prenatal clinics. Other countries surrounding Liberia including Cote D’Ivoire and others along the eastern coast registered prevalence rates of as high as 9 percent.
The idea of mandatory testing of newborns and pregnant mothers has always caused uproar in the world. This is because many psychologists have been arguing that the practice would be tormenting and unethical. They also argue that it goes against the privacy rights of individuals provided for in the bill of rights (Gable, 2007). Therefore, testing people forcibly and then telling them their status may not be the best approach of handling HIV treatment, or even advising people to take preventive measures against it. Psychologists and human rights activists also feel this is not the best ways of encouraging people to take precautions and adopt measures of reducing HIV transmission. However, there are numerous scientific advances that seem to show many benefits associated with people knowing their HIV status. This has been proven by reduced disease prevalence rates in many countries that once had very high rates of the disease. A good example in this case scenario would be a country like Kenya. This is a Sub Saharan country, found in the East African region. In 1997, statistics show that Kenya had a HIV prevalence rate of 14 percent. In 2011, the prevalence rate of HIV in this country was as low as 7 percent. This was accredited to intensified government and private public awareness campaigns that encouraged many people to know their HIV/AIDS status among other disease combating practices.
However, people have always argued whether the advantages of compulsory testing outweigh the private interests, people should not be forced to know the HIV status. This is more so when it comes to addressing newborns and pregnant women in the society. However, developments in science have proven that there are many advantages associated with determining the HIV status of newborns. For instance scientists have managed to prove that chances of a child getting infected with HIV from the mother can be reduced significantly (Kennedy, 2003). This is more so if the pregnancy is still around or just above the third trimester stage. Scientific research shows that these chances can be reduced significantly from about one in every four (1:4) chances of a baby getting infected, to as high as a single case to about fifty chances (1:50). These are the statistics that have led policy makers and lawmakers in the world feel that there should be mandatory HIV testing for all pregnant women in effort of protecting the unborn child. This would be done by starting administering treatment to a HIV positive mother that would protect the unborn child in the womb and also at birth (Gable, 2007). These proposals have not only been going on in third world countries where the prevalence rate of HIV are extremely high; even in the United States there have been many proposals regarding mandatory HIV testing for pregnant mothers.
In the United States, the issues of mandatory HIV testing for pregnant women has sparked a heated debate with people citing the privacy rights of women, and the innocence of the unborn children. In fact, so far there have been state legislatures who have imposed mandatory HIV testing even when women decline to t take the test. For instance, in the states of Connecticut and New York even when pregnant women refuse to take HIV tests, hospitals can go ahead and take the tests anyway and then take the necessary course of action in protecting the unborn child. This course of action leads us to the next question; should consent for new born testing be obtained from their parents.
In this scenario I believe one can argue that parents should have a say on whether their new born or pregnancy should be tested or not. However, innocent children lives are at stake here. I agree that is not ethical to compel someone to take a HIV test yes; but what is more wrong is a mother infecting her own child right at birth when she could have done something that would have saved that child the disease. However, if a pregnant woman agreed to voluntary HIV testing even without having to be compelled, newborns of this era would be born HIV free even when their mothers have the disease. This would ensure that such babies would lead a normal and healthy life without worrying of the effects of the disease. However, response towards perinatal testing lies squarely on the developments that are ongoing in the most recent science. Since these developments in science have already proved to be useful in the intended context, states like Connecticut and New York have already enacted laws that seeks to see that every pregnant mother gets to be tested whether they want to or not.
The following is what recent developments in science show. For starters, it is has been proven by scientists that a pregnant woman with the HIV virus has a baseline of 1:4 chances of transmitting to an unborn baby if no treatment course of action is taken (Besada, 2009). As if that was not enough, this infection seems to occur during delivery since that is the time that the infant becomes exposed to the mother’s blood. This happens because the umbilical barrier that protects the child from mother blood breaks during birth contractions, leaving the child exposed. Science also seems to suggest that pre delivery transmission, also referred to as intrauterine transmission is relatively rare. However, if a mother takes no treatment course of action, even breast feeding alone can infect the child in question.
From science, we have also learnt that a child will always carry HIV positive antibodies if it is born to a mother with the disease. This is because the antibodies are inherited from the mother during development in the uterus. However, recent developments in science show that having HIV antibodies does not mean that the child is infected with the disease. It takes a few months for new born to stop showing antibody results its mother and start showing its true HIV status. After the mother antibodies have disappeared, a child can be free of HIV completely. To reduce mother-to-child transmissions, there are a few critical elements that need to be addressed. One of the critical elements is addressed at the moment of delivery, more so by reducing the viral load of the mother. On top of that, reduction of the blood that a baby is exposed to from her mother during delivery is also essentially important too.
Therefore, when women are asked to take necessary compulsory HIV tests, it is after the interests of young children who do not deserve being born with HIV. Therefore, looking at the above information, I can settle for the pros of compulsory HIV testing in newborns whether their parents get to agree with the practice or not. For starters, compulsory testing facilitates the birth of HIV free children. This is because, the above mentioned practices incorporate the treatment that is immediately initiated once a pregnant mother is discovered to be HIV positive. Additionally, there is also the fact that bearing a healthy generation saves the country as well as the family the child is born into a lot of resources that would be used to purchase medication if the child was HIV positive (Gable, 2007). On top of that, innocent infants are saved from paying because of others infections regardless of how they came to contract them. For instance; since this disease is mostly transmitted by promiscuity, children are saved from paying for other peoples’ promiscuous ways (when that is the case) that may have led them to contracting the disease.
When it comes to the cons of compelling pregnant women to take these tests, there are only two primary factors that come up. One of them is the fact that it is in violation of their privacy rights compelling people to know their HIV status (Besada, 2009). The second one is the fact that there are some women who may see no need of giving birth to HIV positive children only to suffer their entire lifetime. Therefore, it is traumatizing to such women more so if they do not get proper counseling on the advantages of protecting their newborns. This kind of trauma sometimes can even drive some women into committing suicides or even abortion, for they would not want to be the cause of their children future sufferings. However, I believe that the second con can be addressed with proper counseling services as well as medication.
However, in as much as the act of compelling women to know their status is against their rights, I believe it is necessary for the sake of innocent kids. As a result, I believe that parents should not be permitted to decline HIV testing for their children. This is because; some parents are selfish and they may not want to know about anything that may shock them. Others are in fear of testing positive hence they would rather not know their status till the day they die. However, I believe that all expectant mothers should receive constant counseling especially on matters relating to prenatal and postnatal health. This is so that they can be prepared for any situations that accompany pregnancies. This includes knowing the HIV status of their newborns.
After testing positive, the country of Liberia has two treatment methods, and they both rely significantly on the above elements. That is on the reduction of blood contact between mother and the newborn during birth and also on the element of reducing the viral load of the mother. This is done in the AZT program which is the best form of treatment available in the world today. This treatment starts 6 weeks before delivery, and then follows a stage where the mother is given a strong dose meant to reduce the viral load in the mother. This practice alone is believed to reduce chances of transmission between mother and the child from 25 % to as low as 4 %. This percentage is further reduced if the mother chooses to take up the caesarian section form of delivery other than vaginal delivery. This can see the chances going down to as low as 2 %.
The country of Liberia still practices polygamy in some communities, but has high esteem and love for its children. However, there might be a few problems related to proposing compulsory HIV tests for all pregnant mothers in Liberia. For starters, compelling pregnant women to take compulsory HIV tests is rather unethical, especially if it is against their cultures. This may even cause uproar in the country with some people wondering why they would be forced to seek help on the matter while it would be their kids to live with the infection. As if that were not enough, some of these women may not be able to pay for the services since the AZT form of treatment is not for free in this country. Therefore, this would be one the significant challenges in attempting to adopt the recommendations of adopting compulsory HIV testing in the country. On top of that, there is the theory of HIV spreading through polio vaccinations that were carried out around the world in the 1990s. Therefore, I feel that the people of Liberia may decline taking testing thinking they are being infected with the disease and being told they had it initially. Therefore, they might turn the test down and opt to live without knowing their status or even their newborn HIV status.
The recommendations of having a compulsory HIV testing in this country would be a good thing if only they were adopted. This is because; the country would have a chance to raise a healthy generation that would come to serve its economy by becoming reliable members in the society, and with high life expectancy. On top of that, these recommendations would reduce the resources needed in purchasing ARV drugs. This is because it would only be the mother taking them and not necessarily the newborn since it would be saved from the disease. On top of that, people would also practice to live with the disease and those with the disease remain that way for a longer period of time allowing them to lead much productive lives. Therefore, I believe that the country of Liberia stands to gain significantly from compulsory testing.
Besada, H., & Centre for International Governance Innovation. (2009). From civil strife to peace building: Examining private sector involvement in West African reconstruction. Waterloo, Ont.: Wilfrid Laurier University Press.
Gable, L., World Bank., & World Bank. (2007). Legal aspects of HIV/AIDS: A guide for policy and law reform. Washington, D.C: World Bank.
Kennedy, J. (2003). HIV in pregnancy and childbirth. London: Books for Midwives.