Share WORLD Open University Malawi

FACULTY OF Health Sciences

Department of Public Health

PROGRAMME: BSc Public Health

YEAR: 4 Blantyre Campus

COURSE NAME: Public Health Ethics

COURSE CODE:             PUH 413

TO: MR FELIX BANDA

FROM: Bertha Zambasa

STUDENT NO: 24bsc03/2304ph

ASSIGNMENT NO: 1

DUE DATE: 08 /04/2025

DATE SUBMITTED: 07/04/2025

Statement on Plagiarism, Collusion & Academic Incompetence

The University unequivocally condemns plagiarism, which it considers to be comparable to falsifying data and cheating in an examination, and warns students that the Academic Board looks gravely upon incidents of plagiarism. Such incidents are classed as Academic Misconduct which results into a student getting a zero grade.

I,BERTHA ZAMBASA, DECLARE that this work is FREE of plagiarism otherwise I will face consequences thereof if discovered that this work is not supported by proper Harvard referencing and merely a ‘cut & paste’.

Signed…B.Zambasa………………………………………. Date: 11/08/2024

For Lecturer’s use only – Marking Guide

Descriptor	% Mark Range	Student Mark
Work of excellent quality	90-100 % A+
Work of very good quality	75-89   % A
Work of good quality	65-74   % B
Work of fair but below average quality	50-64   % C
Work of marginal quality	40-49   % D
Unsatisfactory, failing work	0-39     % E
Unjustified absence or failure to hand in assigned work in time	0             R

 

 

HIV (Human Immunodeficiency Virus) infection is a viral infection caused by the HIV virus. HIV primarily targets and attacks the immune system, specifically the CD4 cells (also known as T-helper cells) that play a crucial role in coordinating the immune response against infections. When a person becomes infected with HIV, the virus invades body tissues and replicates inside CD4 cells. (Kass et al., 2018).

As the virus multiplies, it progressively weakens the immune system, making the person more susceptible to various infections and diseases. Over time, HIV infection can progress to a more advanced stage known as AIDS (acquired immunodeficiency syndrome). HIV is transmitted through certain body fluids, including blood, semen, vaginal fluids, rectal fluids, and breast milk. HIV infection progresses through different stages. (UNAIDS, 2020).

The first is the acute HIV infection stage, and this is the initial stage immediately after infection, when the virus replicates rapidly. The patient may experience flu-like symptoms such as fever, fatigue, sore throat, swollen lymph nodes, and rash. Chronic HIV infection emerges after the acute stage; HIV enters a chronic or latent phase where the virus continues to replicate at a slower pace. Patients may not have any symptoms during this phase, but the virus is still active and gradually depleting CD4 cells.

In the late stage, which is a continuation of the chronic stage without treatment, HIV infection progresses to AIDS, which is characterized by severe immune system damage. Patients with AIDS are at high risk of developing opportunistic and certain cancers.

Diagnosis of HIV infection is typically done through blood tests that detect the presence of HIV antibodies or the virus itself. Early diagnosis is important as it allows for timely initiation of antiretroviral therapy (ART), which can effectively control the virus, slow disease progression, and reduce the risk of transmission.

 

 

 

 

The Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pandemic has had a devastating impact on sub-Saharan Africa, with Malawi being one of the hardest hit countries (UNAIDS, 2020).

Despite significant progress in expanding access to antiretroviral therapy (ART) and prevention services, many people living in rural areas continue to face significant barriers to accessing these life-saving services (Mwale et al., 2018).

One of the major challenges to ensuring equitable access to HIV/AIDS treatment and prevention in rural Malawi is the issue of stigma and discrimination (Kidd et al., 2018.

Stigma and discrimination

One of the most critical and common barriers to engaging patients with HIV is stigma. Stigma can arise from the external environment, known as social stigma, or from within patients living with HIV themselves, referred to as self-stigma or internalized stigma. Social stigma refers to society’s negative attitudes, beliefs, and discriminatory behaviors towards people living with HIV. It can manifest in various ways, including fear, prejudice, avoidance, gossip, rejection, and discrimination towards patients with HIV.

Most of the people who are affected with HIV face the issues of fear of unknown because they lack understanding about HIV. This fear can lead can manifest as discriminatory behaviors such as excluding themselves from social gatherings or community events.

Stigmatizing attitudes and actions can be driven by misinformation, misconceptions, fear of transmission, moral judgments, and cultural or religious beliefs. Social stigma can result in isolation, social exclusion, loss of social support, diminished self-esteem, and restricted opportunities for employment, education, and personal relationships. It can lead to reluctance in seeking HIV testing, disclosing HIV status, or accessing healthcare services, hindering timely diagnosis and engagement in care. (Kidd et al., 2018).

 

Self-stigma or internalized stigma which refers to the acceptance and internalization of societal negative attitudes and beliefs about HIV by patients. This type of stigma occurs when patients with HIV adopt and believe the stigmatizing messages they encounter in society, resulting in negative self-perception and lowered self-worth. Patients with self-stigma may feel shame, guilt, self-blame, or a sense of worthlessness, leading to self-isolation, diminished self-care, and avoidance of social interactions or disclosure.

This can eventually affect treatment adherence and engagement in care, as patients may internalize negative beliefs about their ability to manage the disease effectively. Addressing both social stigma and self-stigma is crucial for patient engagement in the HIV care cascade and to improving the well-being and outcomes of patients and promoting their engagement in care by creating a more inclusive and supportive environment for patients with HIV, enabling them to engage in care and live fulfilling lives. (Kass et al., 2018).

To address this challenge, healthcare providers should create a safe and supportive environment encouraging patients to participate in their care. Effective patient engagement strategies include education, communication, and support. Education about the disease, its treatment, and its management is essential for patients to understand their condition and make informed decisions about their care. Also, communication between healthcare providers and patients should be open and honest, and patients should be encouraged to ask questions and express their concerns. Programs that provide comprehensive care and support to patients with HIV, including medical care, mental health support, counselling, education, and social services, can improve patient adherence and actively help patients engage in their care process. (UNAIDS, 2020).

Access to healthcare

Patients with HIV often face challenges in accessing healthcare for various reasons, such as transportation, lack of insurance, and limited availability of specialized HIV care, but also financial and language barriers The access also includes language and cultural barriers. Moreover, the financial cost of healthcare can be a significant barrier for people living with HIV, especially in countries with limited resources. Adapting strategies for more vulnerable groups and respecting minority belief systems should also be a tool for improving accessibility.

Finally, drug universality programs should be encouraged, as well as international cooperation for the equitable distribution of new drugs worldwide areas (Mwale et al., 2018). Many rural communities have limited access to healthcare facilities, making it difficult for people to receive treatment and prevention services (UNAIDS, 2020). Even when healthcare facilities are available, they may not have the necessary resources, including trained healthcare workers, equipment, and supplies, to provide adequate care (Mwale et al., 2018).

Mental health issues

Patients with HIV are at increased risk for mental health issues, including depression, anxiety, and substance use disorders. These conditions can negatively impact patient engagement, making it harder for patients to adhere to treatment and regular medical care. In addition, patients with HIV are vulnerable to addiction and substance abuse. Patients with HIV may experience cognitive impairment, including memory loss and difficulty concentrating, which can be caused by the disease or ART medications’ side effects. It is important for healthcare providers to screen patients with HIV for mental health issues and to provide appropriate support and treatment. The integration of recovery theories, exemplified by Recovery Colleges, can be tailored to deliver targeted programs to patients with HIV. This mental health educational approach holds promise in promoting better mental health outcomes, a vital factor in facilitating therapy compliance and overall patient wellness.

Health literacy

Health literacy refers to a person’s ability to understand and use health information to make informed decisions about their health. Patients with low literacy may face challenges in understanding medical information, navigating healthcare systems, understanding their treatment options and medication instructions, utilizing healthcare services effectively and making informed decisions about their care.

This can result in delays in seeking medical care and treatment, negatively impacting patient engagement, treatment adherence, and interaction with healthcare providers. To address these health literacy issues, healthcare providers should provide clear, simple, and transparent information to patients with HIV, using plain language and visual aids to enhance understanding. Patients should also be encouraged to ask questions and seek clarification. Besides, integrating patient partner models into healthcare services can lead to closer alignment with patients’ needs. This approach empowers services to provide more comprehensive and patient-centred care.

The social determinants of health

Poverty, education, and social support, also play a significant role in determining access to HIV/AIDS treatment and prevention services in rural Malawi (Solar et al., 2019). People living in poverty may not have the financial resources to access treatment and prevention services, while those with limited education may not have the knowledge and skills necessary to navigate the healthcare system (Solar et al., 2019). Most of the people who live in rural areas do not have enough money to buy food that can navigate the healthcare system. For example, if people are living in poverty it’s difficult to have enough money to buy nutritious food that can help them. Another social determinant is education, limited education to the issues of HIV may not have positive impact to deal with the issues of healthcare system.

Ethical perspective

Ensuring equitable access to HIV/AIDS treatment and prevention in rural Malawi raises several challenges. One of the major ethical challenges is ensuring informed consent, particularly in areas with low levels of education (Kass et al., 2018). Healthcare providers must ensure that patients understand the risks and benefits of treatment and prevention services, as well as their rights and responsibilities (Kass et al., 2018). Patients should be treated fairly in health care centers regardless of their social status. In any issues regarding client’s informed consent should be applicable by professionals. Practioners should seek informed consent from clients

Another ethical challenge is maintaining patient confidentiality, particularly in small rural communities where everyone knows each other (Kass et al., 2018). Healthcare providers must ensure that patient information is kept confidential, while also ensuring that patients receive the necessary care and support (Kass et al., 2018). It’s not proper for professionals to disclose client’s status, professionals need should maintain confidentiality in any issues regarding clients.

 

 

Finally, healthcare providers must be culturally sensitive when providing HIV/AIDS treatment and prevention services in rural Malawi (Kidd et al., 2018). This requires an understanding of the cultural norms and values of the communities they serve, as well as the ability to adapt their services to meet the unique needs of these communities (Kidd et al., 2018). Professionals need to understand the cultural values of different clients. Cultural sensitivity is one of the most key aspect in service delivery in rural areas.

 

 

 

 

 

Conclusion

The HIV care emphasizes the importance of the engagement of patients at each stage to achieve optimal health outcomes. Adherence to antiretroviral therapy (ART) is a critical component of the HIV care cascade, as it plays a central role in the combat against the virus, improving immune function, and preventing disease progression. However, adherence to ART can be challenging due to several factors, such as stigma, literacy, healthcare access, mental health issues, and other socioeconomic factors. Strengthening the impact of ART involves addressing barriers to care, promoting early diagnosis, improving access to treatment, supporting adherence in HIV care cascade, and providing comprehensive care to enhance the health and well-being of patients.

Nevertheless, patient engagement is crucial for successful HIV care cascade outcomes. It is a complex and dynamic approach requiring healthcare providers to fully understand not only the clinical aspect of the patient but also the patient’s social, cultural, and environmental background without stigma or prejudgment. This diligent consideration of the patient’s unique circumstances is essential for maintaining adherence and achieving successful care outcomes. In this paper we focused on patient engagement and adherence, although barriers and challenges to adherence to the HIV care cascade do not solely originate from patient engagement.

In conclusion ensuring equitable access to HIV/AIDS treatment and prevention in rural Malawi is a complex challenge that requires a multifaceted approach. Addressing the social, economic, and cultural barriers to access, as well as the ethical challenges related to providing ART and prevention services in resource-limited rural areas, is critical to ensuring that all people living in rural Malawi have access to the life-saving services they need.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFERENCES

Yuvaraj A, Mahendra VS, Chakrapani V, Yunihastuti E, Santella AJ, Ranauta A, et al. HIV and stigma in the healthcare setting. Oral Dis. (2020) 26(Suppl 1):103–11. doi: 10.1111/odi.13585

Kip EC, Udedi M, Kulisewa K, Go VF, Gaynes BN. Stigma and mental health challenges among adolescents living with HIV in selected adolescent-specific antiretroviral therapy clinics in Zomba District, Malawi. BMC Pediatrics. 2022 Dec; 22(1):1-2.

Kaunda-Khangamwa BN, Kapwata P, Malisita K, Munthali A, Chipeta E, Phiri S, Manderson L. Adolescents living with HIV, complex needs and resilience in Blantyre, Malawi. AIDS Research and Therapy. 2020 Dec; 17:1-3.

World Health Organization. The World Health Report 2021: Mental health: new understanding, new hope. World Health Organization. Towards a common language for functioning, disability, and health: ICF. The international classification of functioning, disability, and health. 2022.

Republic of Malawi MoH. Malawi Guidelines for Clinical Management of HIV in children and adults.

Kass, N. E., et al. (2018). "Informed consent in low-income settings: A review of the literature." Journal of Medical Ethics, 44(10), 751-758.

 

Kidd, R., et al. (2018). "Stigma and discrimination against people living with HIV/AIDS in rural Malawi." Journal of the International AIDS Society, 21(3), e25112.

 

Mwale, M., et al. (2018). "Barriers to accessing antiretroviral therapy in rural Malawi." Journal of Acquired Immune Deficiency Syndromes, 79(2), 231-238.

 

Solar, O., et al. (2019). "Social determinants of health and HIV/AIDS in sub-Saharan Africa: A systematic review." Journal of the International AIDS Society, 22(2), e25264.

 

UNAIDS. (2020). Global AIDS Update 2020. Geneva: UNAIDS.