The Nursing Initiative Critical Examination of HIV AIDS

The Nursing Initiative & Critical Examination of HIV/AIDS in Central African Republic Shawn Z Stewart, RN, BSN, CCM Thomas Edison State College Nur-600 NG 002 Dr. Constance Morrison December 12, 2009

Abstract The sub-Saharan region of Central African Republic is one of the most poverty stricken areas in the world, and one of the worst affected by HIV/AIDS. Healthcare resources are scarce, with most being relied upon through international humanitarian organizations. This Power. Point will identify current initiatives and suggest new initiatives in the hope of eradicating this epidemic.

Purpose and Objectives • Analyze the current HIV/Aids health initiatives in Central African Republic • Examine the heath issues in Central African Republic • Explore the nursing initiatives in Central African Republic

Major Topics • A look at the progress CAR is trying to make politically in order to create stability • Consider the lack of aid that is received by CAR • Analyze the lack of resources needed to stabilize, treat, and reduce the number of HIV/AIDS cases • A look at the individual initiatives working to resolve the HIV/AIDS crises

Demographics of CAR • Consists of rolling plains 600 -700 meters above sea level • The climate is tropical with hot dry winters and hot wet summers • Slightly smaller than the size of Texas • Annual government budget of $250 million • CAR has a population of just over 4. 5 Million

Political Instability Conflict and political instability surround CAR, as it is bordered by the countries of Sudan, Chad, Cameroon, Democratic Republic of Congo, and the Republic of Congo The population of CAR faces many challenges in its attempt to establish some sort of order

CAR’s Economy • Car’s economy is one of the worst in the world • Per capita income of $700 in 2008 • Economic destitute is the primary factor that has resulted in CAR’s population living in such poor health

Healthcare Personnel • The healthcare personnel available in the central part of Africa are few and far between • 10, 000 patients per physician • 1613 nurses in all of Central African Republic

Morbidity & Mortality • Average life expectancy at birth is 44. 7 years • Infant mortality rate at 112. 9 per 1, 000 births • Contributing factors to these disturbing rates are economic decline, civil conflict, the crushing burden of those infected with HIV/AIDS and a chronically underfunded health regime

Education • The educational system requires only 6 years of primary education • The compliance rate is a mere 55%, often due to ethnic barriers • The education deficit has handicapped the population making it difficult to improve health awareness

Health Challenges Facing CAR • • • Population with sustainable access to improved drinking water 66% Population with sustainable access to improved sanitation 31% Number of physicians (per 10, 000 population) <1 Number of pharmaceutical personnel 17 Prevalence of HIV among adults 15 and older (per 100, 000) 9990

HIV/AIDS • Most affected country in the region by the HIV/AIDS pandemic • Antiretroviral therapy among people with advanced HIV 6% • Ranked ninth in the world • More than 240, 000 persons estimated to be infected • Rural areas have an infection rate as high as 20%

HIV/AIDS • Drastically affects the country’s productivity due to absenteeism and has stunted economic growth • Healthcare benefits barely exist with only 4. 2% covered by anti-retroviral therapy • Teachers rank highest in mortality at 86% creating a positive feed back loop in quality of education

Global Humanitarian Assistance for HIV/AIDS • The goal is to work as one to conquer illness and disease throughout the world • HIV has shown how rapidly it spreads in its short 25 year history it has covered the globe • Governments fear if HIV/AIDS is not dealt with in all areas those in need will flee to other countries where healthcare is available

International Healthcare Organizations • Without significant assistance in supplies, treatment, and education this country will continue to become less productive and their economic future will become more dismal • International healthcare organizations involved in the delivery of health care directed at the HIV/AIDS epidemic include the United Nations Development Program and National Coordination of the National AIDS Control Committee of the Government of the Central African Republic

Initiatives Working to Resolve the HIV/AIDS Crises

Strengthening Overall Care for People Living with HIV/AIDS • Initiative started in 2003 • Aim is at scaling up voluntary counseling, testing, and prevention of mother to child transmission • Providing greater access to antiretrovirals

Strengthening Overall Care for Orphans and Other Children Affected by HIV/AIDS • Focus on minimizing the impact on orphans and other young children • To assure that they are able to receive access to basic services such as medical care, support, and education

Extension, strengthening and decentralization of comprehensive care of persons living with HIV/AIDS • The focus of improving quality interventions for HIV patients • Directed through reduction of risk in vulnerable populations, reduction in morbidity and mortality, and the reinforcement of coordination and monitoring

HIV/AIDS Business Coalitions • Development of national business coalitions against HIV/AIDS • Intended to facilitate public-private partnerships with key stakeholders such as international donor agencies

Applied Information, Communication and Technology (ICT) Sector Focused On HIV/AIDS • The CCA HIV/AIDS Initiative works with ICT sector companies, the U. S. , international donor community, the African public- private sectors, and health associated industries • Introduced to create partnerships that will effectively engage the skills, products and expertise represented in the diverse landscape of applied information technologies

The Global Fund HIV Education Prevention Campaign • In the urban parts of CAR, such as Bangui, the capital city, there is an active campaign to educate the population • Included is billboards, free medications, group education and free condoms

The Possibility of New Initiatives Specific to Nursing

Development of New Initiatives • Nursing could launch a new initiative in collaboration with The Corporate Council on Africa (CCA) • A venture to provide telenursing to the underprivileged populations • Focused on direct observation therapy (DOT) for managing adherence to antiretroviral drug therapy • Nurse volunteers from all over the world could participate in the initiative

Barriers to The Telenursing DOT Initiative • Compliance with participation in the telenursing DOT initiative • This barrier could be overcome through education and promotion of the cause through the use of solicited media donations

Effectiveness of The Telenursing DOT Initiative • Participation in the program would be utilized as a key indicator as to whether or not there was the possibility of making a significant impact • A control group could be compared against those who were compliant in the intervention group to determine impact in blood counts and viral loads

Wrapping It Up • HIV/AIDS epidemic is in desperate need of intervention • It is only through availability of anti-retroviral treatment and a significant increase in education that this war can be fought • Nursing could take a leadership role and initiate a new concept in direct observation therapy to increase compliance with anti-retroviral medications

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