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Running head: HIV/AIDS 1

HIV/AIDS.

Student’s Name:

Institutional Affiliation:

HIV/AIDS 2

ABSTRACT.

The aim of this paper is to present a research proposal on the research question-

Research question-“Why HIV & AIDS is a significant public health issue requiring further

research?” Interpreted I other words, the research’s aim is to study emerging issues in the

treatment or control of the disease so that the world health community does not reach a

“comfort zone” with the implication that the disease is already under control. Specifically,

key issues to be discussed include the emergence of treatment resistant HIV, side effects of

treatment, research and development capacities, emerging behaviors like concurrent sexual

relationships and inadequate surveillance. To successfully complete this study, the research

will engage in a primary research where literature relating to the aforementioned concepts

will be reviewed. To this extent, a team of 300 respondents will be divided to 4 categories

namely (1) persons living with HIV, (2) health care professionals and (3) counselors

especially on marital issues. To be ethical, the research will emphasize on the anonymity of

respondents, citing used materials, honest reporting and due diligence. However, the

methodology section must be preceded by the literature review section whose main role will

be to review the input of other scholars in relation to the topic. Finally, the proposal will

finalize with the conclusions where the limitations and key ideas observed in the study will

be highlighted.

Key Terms: HIV/AIDS, ARVs, Transmission, Testing, Sexual Intercourse, Sub-Saharan

Africa.

HIV/AIDS 3

Introduction.

Immediately after emergence, the HIV virus spread quickly and before observation, it

was already a pandemic. In the 3 first decades following the emergence of HIV/AIDS, 1980s,

1990s and 2000s, the disease was studied and combated in an aggressive manner. Since 2001,

the infection of children during birth had decreased to 52% and by 2005, the AIDS-related

deaths had also fallen to 30%, a transition that is attributed to ARVs (Damle, 2013). In

addition, the knowledge for the prevention, treatment and control for the disease is now

widespread. Despite these attainments, and after a thorough investigation on existing

literature, this research accepts that the bulky work is yet to be done hence the emergence of

the research question introduced in the abstract- -“Why HIV & AIDS is a significant public

health issue requiring further research?” For example, emerging factors that place

individuals at risk are yet to be explored, cost-effective prevention methods are unexplored,

additional decentralization of testing equipment, drug resistance, side effects of treatment,

research and development capacities, emerging behaviors like concurrent sexual relationships

and inadequate surveillance.

HIV/AIDS 4

Literature Review.

Drug resistance.

To begin with, researchers must now accelerate consultations on why the HIV-virus

could be developing resistance to drugs and how the problem could be contained or better

still, be eliminated. Indeed, Waters (2018) accepts that indeed, the virus is mutating and in a

short time, modern and effective drugs will lose that status. To speak generally, and as argued

by Waters (2018), the virus begins to multiply (replicate) once it enters the human body.

During these replications, the virus changes in form thereby giving an opportunity of

mutation. Here, the problem arises if the virus mutates in a way that is resistant to ARVs or

other similar medications. Worse still, drug resistant viruses can be spread from one infected

person to another thereby introducing a new generation of the virus altogether.

To worsen the situation, the risk of cross-resistance is also imperative. To elaborate,

cross-resistance occurs when a person’s viruses become resistant to drugs that the person has

not taken in the first place (Fogel et al., 2016). To explain how this occurs, HIV drugs are

divided into classes which are primarily defined by how the drugs work. As a result, once a

HIV positive person develops resistance against a particular drug, such resistance may extend

to other drugs in that class as well. Also, drug resistance arises from poor medication more so

stoppage or skipping. To describe, once a HIV positive person stops to take medications or

skips some intakes, an opportunity for the virus to replicate arises. In the process, the risk of

resistance development heightens (Tostevin et al., 2017).

HIV/AIDS 5

Behavioral Change.

After its discovery about 4 decades ago, the rapid spread of the HIV virus was blamed

on a list of behaviors. To be sure, these factors were divided into four categories namely (1)

individual level factors, (2) Societal level factors, (3) health infrastructural level factors and

(4) structural level factors. The table below outlines the details of these factors.

Factors

Description.

Individual level.

This class entails factors that people can control in their

capacities. For example, refusal to use condoms, having many

sexual partners, sex with infected persons, lack of knowledge

and having sex during menses.

Societal level.

This class entails societal factors that encourage the risk of

transmission. For example, rejection of male circumcision,

social status against women, societal disregard of condom,

wife inheritance and interchanging spouses.

Health infrastructural

level.

This class entails factors of the health care system over which

the person has little or no control. For example, poor

availability of condoms, poor communication services and

poor STD treatment services.

Structural level.

This class entails factors of development over which the

person or the health care system have little or no control.

Example of these factors include civil unrest, unemployment,

poor policies and low literacy levels.

HIV/AIDS 6

Although these factors are important considerations in the control and treatment of

HIV, most of them have been emphasized so that additional efforts fail to make any

significant changes. For instance, a significant population of the world’s population

understands that a condom is a useful method in preventing the spread of HIV virus.

Likewise, significant portions of the population understand that sharing of sharp objects like

knives, needles and razor blades increase the risk of transferring the HIV virus. As a result,

researchers should now carry the study to the next levels especially on understanding how

these behaviors could be regulated or contained. For example, countries like Germany

Netherlands and Turkey legalized prostitution in a bid to regulate the interactions therein.

Indeed, research has shown that where prostitution is legal, the persons involved find it easy

to operate in safe and dignified environments as opposed to brothels. Furthermore, such

persons find it easy to seek medical attention in the events of exposure like rape. Equally,

other countries have extremely severe punishments to the extent that persons at risk prefer to

remain hidden. For instance, Netherlands subjects most drug abusers to life imprisonment.

As a result, drug abusing individuals may refuse to seek help or lack access to additional

syringes.

Concurrent Sexual Behavior.

In addition to the emerging behaviors discussed above, Concurrent Sex (CS) could be

taken as a whole new behavior on its own (Haberer et al., 2017). In previous studies, CS has

been seen to increase the speed at which HIV spreads within a population, the extent of such

spreading, it’s persistence as well as introduce other factors like drug resistance. To put the

concept simply, a situation is assumed where a couple (composed of a man and woman) have

two extra marital partners each. In total, such a circle contains 6 sexual partners all of whom

are interconnected. As a result, the entire circle is at risk immediately one of them catches the

HIV-virus (assuming that condoms are not used).

HIV/AIDS 7

Indeed, CS has been described as riskier than serial monogamy. Of note, serial

monogamy requires one relationship to be closed before another is started (Huang et al.,

2014) As such, if a virus is introduced to a relationship, it cannot be spread as long as the

relationship lasts. Although scientists have already established that CS accelerates the speed

at which HIV spreads and even increases its persistence, additional research needs to be

conducted in a bid to establish how the behavior relates to HIV and how the risk could be

reverted.

Research and Development.

Currently, the HIV-virus has been in existence for over 4 decades. Although many

stakeholders may argue that the fight against the disease has made significant steps, like

developing the ARVs and Post exposure prophylaxis, the truth is that HIV is still prevalent

and continues to claim many lives. According to the world health organization (WHO), over

70 million persons have been infected with the virus since its emergence (Rhodes et al.,

2017). Worse still, about a half of these have died and as per the end of 2016, about 36

million persons were living with the virus. Recently, the United States announced that Gay

and bisexual men accounted for slightly over a half of persons living with the virus. In 2015

alone, about 38,500 Americans caught the virus. Moreover, more populations have been seen

to catch or spread the virus than the others. For instance, 15% of women living with the virus

are aged 15-24 years an even more notably, 80% are in the sub-Saharan Africa. Moreover,

women of this age bracket catch the virus about 7 years earlier than their peers. Moreover,

women in eastern and southern Africa are more infected than men (Bernard et al., 2016).

HIV/AIDS 8

Research Gap.

Although the outcomes of literature review that the content is sufficiently useful,

specific sections show a research gap that demands immediate attention. To start, literature

has shown that concurrent sexual behavior is at the forefront of spreading the disease.

Nevertheless, underlying issues that encourage the behavior like divorce and drug abuse have

been pushed out of the discussion. Moreover, literature has discussed how the disease’s first

phase has been defeated and declined from 20% infection rates in some countries to slightly

over 10%. In that phase, the epidemic was associated with specific classes like the

commercial sex workers and MSM (men having sex with men). That being said, the literature

reviewed thus far failed to identify that the 2

phase of HIV dominance is possible and has

been reported in some countries. To be clear, this phase starts with a speedy spread of the

virus despite the sped having been cut in previous decades. To eradicate the risk of the 2

phase, stakeholders require to intensify prevention efforts as well as fight the stigmatization o

HIV positive persons. Last but not least, literature review over emphasized research against

the disease in relation to factors that are related to the first phase of the fight against HIV.

Indeed, specific developments have been observed and which in the view of the many have

revolutionized the fight. For instance, the improvement of testing equipment so that the

window period has been cut from six months to 18 days. For instance, it occurs that a specific

portion of the world’s population prefers to remain untested and counselling services are not

at the disposal of such populations. At the same time, further investigations on the

decentralization of testing services must be conducted.

HIV/AIDS 9

Research Question.

As mentioned in the abstract, the research question for this study reads as- “Why HIV

& AIDS is a significant public health issue requiring further research?” To put the question

in context, this study intends to remove the risk of “relaxation” with the world feeling like the

disease has already been defeated. To be effective, the population will compromise of three

categories of namely persons living with HIV, health care professionals and counselors

especially on marital issues. Furthermore, the sample will comprise of a representation of 50

persons from each of these groups of population.

Methodology.

Research Design.

To speak in simple terms, the type of design used for this research is non-

experimental research. According to Krosnick (2018) such a research avoids the manipulation

of situations or variables in question. More specifically, the study will evaluate relational

designs where a range of variables will be measured. In simpler terms, these types of studies

may also be referred to as correlational studies because they are about measuring the extent

of interactions between variables like in this case, HIV-virus and emerging issues like

resistance to ARVs.

Population and Sample.

In this research, the population is divided into two layers namely the global

population and national population. Regardless of the perspective taken, the population

comprises of three categories of persons. They include persons living with HIV, health care

professionals and counselors especially on marital issues. To add, the population entails

people living in Georgia, one of the states believed to have the highest rates of HIV.

Specifically, about 31.8 persons per 100,000 are HIV positive.

HIV/AIDS 10

On the side of sampling, the study will rely on probability method of sampling. Here,

all persons within the population will have equal opportunities of joining the sample

(Krosnick, 2018). To attract the respondents, the study will rely on the records of two public

hospital in the state. For anonymity the names to these hospitals will be withheld and instead,

labels of Hospital X and Hospital Y will be used. Once the records are obtained for persons

living with the virus are obtained (with informed consent), a list of about 300 persons is

anticipated. From here, every 6

respondent will be eligible for inclusion thereby creating a

16.67% chance of inclusion for all elements.

Data Collection.

To collect data, the study will rely on questionnaires which according to Brinkmann

(2014) represents a list of related questions. To be effective, the questionnaires will divide

into 3 sections each of which will be designed for each of the 3 categories of respondents.

Noteworthy, the questioners will be dispatched through the Goggle’s email system which is

instant, secure and free. Specifically, participants will be put through an orientation program

(lasting 1 week). After the program, the team will dispatch the questionnaires which shall be

supposedly retuned after 3 weeks. Thereafter, the stage of data analysis will commence and

last for 3 weeks before the final report is compiled for another 2 weeks.

Data Analysis.

Given that the study is primary, the easiest and most effective method of data analysis

will be the statistical approach. Specifically, the team will use the averaging, standard

deviation and regression methods. Pointedly, regression analysis will assist by establishing

the extent of dependability between dependent and independent variables.

HIV/AIDS 11

Research Reliability and validity.

Summarily, reliability implies the extent to which the outcome of a research could be

repeated after another analysis (Noble & Smith, 2015). To be reliable, this study will use a

reasonably large sample so as to eliminate the risk of mis-interpretation of special

characteristics. On the other hand, data validity is the extent to which the findings of the

study would be translated to define the entire population (Silverman, 2016). To ensure

validity, the research will apply the principle of respondents’ validation where the findings

are presented to the respondents for scrutiny.

Cost and Duration.

Activity

Estimated Duration

Estimated Cost

Sampling

4 weeks

$ 6,000

Orientation

1 week

$ 5,000

Data collection

3 weeks

$ 1,000

Data Analysis

3 weeks

$ 1,000

Reporting and compilation

2 weeks

$ 1,000

Others

3 weeks

$ 1,000

Total

16 weeks

$ 15,000

In summary, the project will continue for 16 weeks (4 months). Specifically, the key

milestones of that project will include sampling, orientation, data collection and analysis and

reporting. In total, the budget is expected to extend to $ 15,000 although a reserve of $ 2,000

will be availed for emergencies.

HIV/AIDS 12

Ethical Considerations.

Being a primary research on sensitive matters (HIV status), the primary ethical concern will

entail factors highlighted by Battiste (2016). They include but are not limited to (1) informed

consent, (2) anonymity of respondents and (3) dignified interactions with respondents.

Conclusion.

To conclude the analysis, this proposal finds that the upcoming study is of extreme

importance not only to the fight against HIV/AIDS but also to public health. To begin with,

the world is already aware that the HIV can spread at a ferocious speed especially when the

environment is uncontrolled. Slightly over a decade since discovery, it had already infected

40 million persons with about 14,000 new infections being estimated each day. At the end of

2002, over 40 million persons were living with the virus 30% of whom had secondary

infections. In several nations, the epidemic had cut life expectancy with over 10 years.

Moreover, the disease is known to cause or accelerate poverty, exaggerate the number of

orphans, deprive governments of resources and start domestic violence. Nevertheless, it is

apparent that a list of difficulties will surface. To begin with, the return rates of

questionnaires are expected to be low as HIV positive persons are likely to lose their

willingness to engage in the study. To this extent, the study risks a situation where the

recruitment process would be repeated. As a result, the exercise will also suffer financial

difficulty. To mitigate the issue, an emergency fund of $ 2,000 will be put in place although

there is no guarantee that it is a sufficient caution. Finally, the research expects to face the

challenge of time shortage. For example, the schedule anticipates to receive the

questionnaires back in about 3 weeks, analyze data in two weeks before compiling the end

reports in another two weeks. However, this time is set to the lower limit and unprecedented

delays could devastate the schedule.

HIV/AIDS 13

References.

Battiste, M. (2016). Research Ethics for Chapter Protecting Indigenous Knowledge and

Heritage. Ethical futures in qualitative research: Decolonizing the politics of

knowledge, 111.

Bernard, C. L., Brandeau, M. L., Humphreys, K., Bendavid, E., Holodniy, M., Weyant, C., ...

& Goldhaber-Fiebert, J. D. (2016). Cost-effectiveness of HIV preexposure

prophylaxis for people who inject drugs in the United States. Annals of internal

medicine, 165(1), 10-19.

Brinkmann, S. (2014). Interview. In Encyclopedia of critical psychology (pp. 1008-1010).

New York City: Springer.

Damle, S. G. (2013). HIV/AIDS–Accomplishments and challenges?. Contemporary clinical

dentistry, 4(4), 419.c

Fogel, J. M., Hudelson, S. E., Ou, S. S., Hart, S., Wallis, C., Morgado, M. G., ... & Sabin, D.

(2016). HIV drug resistance in adults failing early antiretroviral treatment: results

from the HIV Prevention Trials Network 052 trial. Journal of acquired immune

deficiency syndromes (1999), 72(3), 304.

Haberer, J. E., Ngure, K., Muwonge, T., Mugo, N., Katabira, E., Heffron, R., ... & Baeten, J.

M. (2017). Brief Report: Context Matters PrEP Adherence is Associated With Sexual

Behavior Among HIV Serodiscordant Couples in East Africa. JAIDS Journal of

Acquired Immune Deficiency Syndromes, 76(5), 488-492.

Huang, Y., Abler, L., Pan, S., Henderson, G. E., Wang, X., Yao, X., & Parish, W. L. (2014).

Population-based sexual behavior surveys in China: Liuzhou compared with other

prefectural cities. AIDS and behavior, 18(2), 118-125.

HIV/AIDS 14

Krosnick, J. A. (2018). Improving question design to maximize reliability and validity. In The

Palgrave Handbook of Survey Research (pp. 95-101). Palgrave Macmillan, Cham.

Noble, H., & Smith, J. (2015). Issues of validity and reliability in qualitative

research. Evidence-Based Nursing, ebnurs-2015.

Rhodes, S. D., Alonzo, J., Mann, L., Song, E. Y., Tanner, A. E., Arellano, J. E., ... & Painter,

T. M. (2017). Small-group randomized controlled trial to increase condom use and

HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with

men. American journal of public health, 107(6), 969-976.

Silverman, D. (Ed.). (2016). Qualitative research. New Castle: Sage.

Tostevin, A., White, E., Dunn, D., Croxford, S., Delpech, V., Williams, I., ... & Pillay, D.

(2017). Recent trends and patterns in HIV‐1 transmitted drug resistance in the United

Kingdom. HIV medicine, 18(3), 204-213.

Waters, L. (2018). What healthcare professionals can do to help limit HIV

Resistance. Stroke, 13, 57.

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