HIV/AIDS among the gay Men in Australia
HIV/AIDS has been on increase and is causing death more than any other disease in the whole world. However, changes have been occurring in the pattern of the HIV infection between the two genders. Early infections were high among the homosexuals and among those people who live under intravenous drugs. However, the pattern changed to heterosexuals and the rates are especially higher among the females than among the males.
In Australia the case is different research has shown that there is increased risk of HIV infection among the young gay men (Centers for Disease Control and Prevention; O' Connell et al; Weber et al. cited in Prestage et al. 2009). The young gay men have been thought to be at increased risk because of their higher sexual vulnerability, their limited experience on HIV since they lack the life exposure and also due to the fact that they are sexually active (Ekstrand & Coates; Hayes, Kegeles & Coates; Koblin et al. cited in Prestage et at. 2009). The young gay men have also been found to be engaging in unprotected anal sexual intercourse in some parts of Australia (Prestage et al. 2009).
For this reason the paper will be discussing and analysing the concept of HIV/AIDS awareness among men who have sex with men, including risk management in relations to their age and sexual behaviours. The paper will also discuss Australia's relations with its gay community and the government initiatives to prevent spread of HIV infection. The care giving between the members of the gay community who has HIV infections will then be discussed, thus, analysis of the subject will be provided. Finally, the nursing considerations and nurses role in coordinating care for the HIV/AIDS patient will be covered.
HIV/AIDS awareness among gay community
One of the major solutions to the high spread of HIV in Australia is by voluntary testing and counselling of the nationals (Jin 2002). The rate of HIV testing is however high among the members of the gay community in Australia compared with the other developed countries. A study that was done to assess the contribution of voluntary testing and counselling among the gay community revealed that young men are the most frequent in testing centres due to their engagement in short term relationships that leaves them with the need for testing of their status (Jin 2002). However, most of the gays whose been found to be HIV infected are started on anti retroviral therapy.
A study carried out in Australia by Prestage et al (2009), revealed that there is a profound and sustained pattern change in the sexual practise of the young gay men. A decrease in the act of unprotected anal sexual intercourse was noted and also a trend towards the use of condoms. In another study of risk management and harm reduction among gay men in Sydney, showed that gay men uses strategies when having sexual intercourse to manage the risk of getting infected of HIV. Though the risk-management strategies are more safe than others it does not eliminate the risk of HIV transmission (Van den Ven 2004).
Australia's Relations with its Gay community
With the members of the gay community being the most affected by HIV and AIDS discrimination relating to HIV is so intimately bound in the relationship between the Australians and its gay community (Dowsett 2003). Regardless of the HIV history that defines its transmission through sexual intercourse rather than a blood carried disease (Horton & Aggleton, cited in Dowsett 2003), The whole issue is usually looked down upon by the members of the gay community. This is the reason why the discursive definition of HIV usually takes into account the language of the gay rights more of which was borrowed from the political fights in the United States. It is assumed that in most discussions on HIV and AIDS related discrimination, its roots are founded in the anti gay sentiments and action (Dowsett 2003).
HIV infection prevention strategy in Australia
The state of HIV infections in Australia can be differentiated from other countries based on its history in Australia. When the disease was first diagnosed in Australia, anti gay laws had been only reformed in two states where male homosexuality had been made legal as a result of the efforts by a gay liberation movement that had started in 1970 (Dowsett 2003; Rowe & Dowsett 2008). When the era of HIV pandemic came, the other states reformed their laws and also legalized homosexuality and this was followed by an enactment of legislation that was against discrimination of the homosexual in the work places, housing and in provision of services base on sexual orientation/sexuality. This was noted as an achievement by the Australian government (Dowsett 2003). This act brought changes to the laws regarding sex but a national worry as a response to the increases in the HIV spread. As the pandemic continued and the cases of infection increased, other states such as the New South Wales modified a public health rule that added HIV and Aids to the list of the significant diseases in Australia (Dowsett 2003).
The act at New South Wales led to subjection of the AIDS victims to various rights of public health support acts. Law was also passed in the state that made it illegal for the HIV infected persons to have a sexual intercourse without informing their partners of their HIV status (Dowsett 2003). The law is however hard to enforce and it has never been used since it was passed but other provisions of the public health act have been in use. These include the enforced counselling imprisonments of the HIV infected persons who break the law (Dowsett 2003).
Care giving between gay community
Before triple therapy was introduced among the people living with HIV/AIDS, the disease was devastating and leads to an early death of the gay men who got infected. The gathering of support from all corners of the gay and lesbian community to give help to their fellow members who are infected has been a joint effort (Munro & Edward 2008). Due to the body wasting that follows the infection of HIV/AIDS, the humiliation goes higher especially among the gay men who place high value on the image of their bodies (Anderson & Mac Elveen-Hoehn cited in Munro & Edward 2008).
The treatment for HIV is also viewed through homophobic eyes (Anderson & Mac Elveen-Hoehn cited in Munro & Edward 2008) and this contributes to the humiliation that is brought by the disease. People view AIDS as being obviously fatal (Munro & Edward 2008) and a source of discouragement to the patients. In giving care for a HIV infected person, one needs a clear understanding of the illness, the pain it is causing and the suffering that the patient is experiencing. This will help in development of a nursing relationship between the caregiver and the patient (Munro & Edward 2008). The members of the gay community are therefore much unified in care giving for their fellow male infected members due to the discrimination that they sometimes face in the community that they live in.
Considerations for nurses in giving care for HIV/AIDS patients
The nurses are the major caregivers for the HIV and AIDS patients. This is a rather difficult task that needs some special considerations. Among the things that the nurses need to consider are the age of the patient, stage of the infection, immunity of the patient and the nutritional status (Pratt 2003; Shaw & Mahoney 2003). The age of the patient is very important since care cannot be given in a similar manner for grown up people and for the children. Children have different health needs from the mature people. Some of the special needs for children are on the type of food and the environment. This is also important because most cases of infections in children start at birth where the virus is passed from mother to the child (Pratt 2003; Shaw & Mahoney 2003). This should however be considered since it is also an important factor on the drug prescription. Older people who are infected with HIV also have different needs since their body demands also change (Shaw & Mahoney 2003).
The stage of infection is also important because some people are at the symptomatic while others are in the asymptomatic stage. Others are even in the critical condition therefore require different care. Some of those who are in the critical condition are on anti retroviral therapy and on top of the need for the common care for all HIV patient, they will require special care and guidance on the use of the drugs (Pratt 2003; Shaw & Mahoney 2003). The drugs have their own side effects and a system of taking them and therefore the patient must be well monitored while taking them. The other consideration is on the level of immunity and the nutritional status of the patient. Nutrition plays a very big role in determining the immunity level of an individual (Pratt 2003). A HIV patient must have high level of immunity to enable him/her to fight the opportunistic infections that comes when one has AIDS (Shaw & Mahoney 2003). The nurse should therefore consider the immunity level of the patient before administering the care since this will enable him or her to know the type of food that the patient will require. The other factor that the nurse should consider is the duty of confidentiality (Shaw & Mahoney 2003; Mair 2008) because of the stigma attached to the disease the nurse need to be extra careful in looking after the patient with HIV/AIDS. The nurse need to be aware at all times that the patient care documentation is always kept in a secure area and not visible to public. The nurse also has the responsibility not to disclose any information regarding the condition of the patient to any other individual. Lastly and most importantly the nurse should take all the precautionary measures when attending to patient care especially when it comes to taking blood samples from the patient, to avoid or prevent contracting infections from the HIV/AIDS patient, for his/her own safety as well as the safety of the other patients (Pratt 2003).
Role of the nurse as the coordinator of care
When the nurse is coordinating the care for the HIV patients, he or she has several roles to take charge of. The first one is the assessment of the patient physical emotional and mental health status (Pratt 2003; Shaw & Mahoney 2003; Komiti et al. 2005). The patients have different health status depending on the stage of HIV infection. The nurse should also liaise with other healthcare professionals such as the dietician, mental health nurse /psychologist and patients own general practitioner in relations to regular monitoring of the patient physical and mental health status (Pratt 2003; Shaw & Mahoney 2003; Komiti et al. 2005). Another role is giving patient education the nurse should educate the patient as well as the caregivers about the disease (Pratt 2003). Since HIV can be contracted especially where the patient and the caregiver both have open sores, it is very important for the coordinating nurse to explain to them on how they can protect themselves from infections. The other role is establishment of patient support network, with the patient consent and well informed understanding of the importance of social support the nurse can refer the patient to join support program and organizations specific to HIV/AIDS for a collective education and networking. When they are networked, the stigma that follows the realization of one's infected status is reduced. The patient can also be networked with some relevant funding agencies that can sponsor the training and also provide funds for their medication, food and other special needs (Pratt 2003; Shaw & Mahoney 2003).
With the current increase in the rates of HIV infection among the gay community in Australia, there is a need for the HIV/AIDS awareness program not only on the gay community but the whole country. Education about HIV/AIDS infection prevention should be encourage among the young people particularly the young gay men due to their engagement in short term relationships and casual sex. The act that led to the legalization of the gay sexual behaviour should be reviewed to reduce the high spread of HIV infections and must also include the compulsory requirement of protected anal sex. The care for HIV patients should also be well looked at since proper nutrition and immunity increases the chances of an individual to live longer. Nurses have the key role in the management of care for the HIV/AIDS patient therefore the nurse need to consider all the factors in planning nursing care for this particular population. The nurse should also have to undergo appropriate training and continuous education in order to have the necessary information and skills in caring for the HIV/AIDS patient.
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