Epidemiological methods are used in a variety of public health areas (including infectious disease, chronic disease, and social health) and settings (including the community, schools, and the workplace). Epidemiological methods are used to assess, describe, analyze, and make comparisons of populations to inform evidence-based practices, policies, and interventions. Propose a study based on the methods you have learned thus far designed to investigate an association within one of the public health areas listed (infectious disease, chronic disease, or social health) and the methods you would apply. Discuss and define the risk factor or exposure that is being assessed, the method of comparison that is used, and the setting or situation (community, school, workplace, etc.) your study would look to address. Consider the concepts of causal inference, measures of association, and study design.
RUNNING HEAD: TRANSMITTABLE INFECTIONS 1
Epidemiological profile of HIV in New York
Grand Canyon University
Human immunodeficiency virus is a condition that affects human beings causing a weak immune system (CDC, 2019). The HIV virus attacks CD4 cells otherwise known as T cells, the cells that are responsible for adaptive immune response of the body. As a result, the virus weakens the body’s general response to any other infections and leads to Acquired Immune Deficiency Syndrome (AIDS). If unmanaged, HIV results to death by opportunistic diseases. HIV is transmitted from an infected person to a healthy one through exchange of body fluids including semen, vaginal fluids, blood, saliva, and other body fluids. It can be contracted through having unprotected sexual relations with an infected person, mother to unborn child, blood transfusion, unhygienic practices like using unsterilized scalpels and many others. The infection has been around for quite some time and despite the efforts to manage it, it still persists because of a number of factors beyond the control of the health care system. HIV is termed as one of the medical wicked problems because of the ide scope of factors that contributes to its persistence and spread. This epidemiological profile of HIV is aimed at providing statistics of HIV in New York State and the larger United States, describing social, demographic, behavioral, geographic and other social characteristics of how HIV is spread and what contributes to its persistence and some explanations to behavioral intent of target populations resulting in to HIV spread. This report will be insightful to decision makers, program planners and other nongovernmental organizations concerned with the spread of HIV in the New York state. With an understanding of demographic characteristics, coupled with statistics and descriptions of behavioral characteristics of target populations resulting into the spread of HIV, it is possible that the infection can be managed by ensuring implementation of strategies aimed at mitigating some of the social triggers outside the control of public health including social campaigns to reduce the spread.
National HIV surveillance system is a subsidiary of the Center for Disease Control and prevention and forms the central agency that monitors HIV trends in the United States. In addition, it also funds different health departments at state and local levels in the collection of the information towards HIV. This information is used by the Centers for Disease control and prevention to determine populations that are being affected and reasons as to why they are being affected.
According to KFF, (2020) the population of New York state based on American Community Survey indicates that 21.7% of the population consists of children between the age of 0 and 18 years, 18.6% between the age of 19 to 25, 13.4% between the age of 26 to 34, 25.7% between the age of 35 to 54, 13 .6% between the age of 55 to 64 and 16.9% of the population above the age of 65.
The total number of residents in New York state is 18,908,300. Out of this population, 90.8% consists of citizens of the United States, while the rest making up 9.2% consists of non citizens. 55.2% of the population is white, 14.0% black, 19.3% Hispanic, 8.6% Asian and 0.2% of Indian/Alaska origin. 2.7% of the population of New York State consists of people from multiple races. Considering distribution of the population by sex, 48.4% are male while 51.6% are female. 30.6% of the population consists of adults with children while 69.4% consists of adults with no children.
These statistics of New York State will help to form a backdrop against which certain demographic characteristics will be evaluated in the subsequent sections of this paper. Judging from these statistics, much of the population consists of people below the age of 54 years. Also, New York State is considered Metropolitan with people from many different ethnicities. The social economic structure of this state is also diversified in that, it consists of people from above, within and below poverty lines. These characteristics will help to inform why certain numbers of HIV continue to persist.
Description of available data
HIV surveillance annual report, and the Centers for Disease control and prevention are the two sources of data that were used in this epidemiological research. According to statistics of the year 2019, approximately 1.1 million people in the United States while living with HIV (Miami Times, 2020). One out of every seven people do not know their HIV status. In a report provided by CDC at the end of 2018, 1.2 million people above the age of 13 years was diagnosed with HIV with an approximate number of 161, 800 having not been diagnosed. In the same year, 37, 968 new cases were reported in the entire country. Those aged between 13 to 14 were 120, 15 to 19 were on 1,719, the ones aged between 20 to 24 were 6,152, those aged between 25 to 29 having 7768, 30 is to 34 years being 5723, 35 to 39 years were 4250, 40 to 44 were 3025, 2861 being between the age of 45 to 49, and those age between 50 to 54 years were 2528. Those age between 55 to 59 were 1877, 60 to 64 years were 1058 while those that were 65 years and older one 900 (CDC, 2020).
Of this population, 186 were American Indian/Alaska native, 875 were Asian, 16,002 were African American, 10,246 were Latino, 68 were native Hawaiian, 9560 whites while 944 multiple races. In New York state, the rate of HIV diagnosis was 14.1 per every 100,000 people in the population, 23.4 being male 5.5 being female. According to ethnicity, the rate per 100,000 population for whites was 3.8, 41.4 for black American, 27.8 for Hispanic, 4.14 Indian/Alaska native, 4.9 Asian, and 35.0 multiple races. The statistics revealed that 765.3 people per 100,000 population of adults and adolescents in New York state were living with HIV (KFF, 2020). 70% of annual new HIV infections occurred between gay men and other men who have sex with men. Among this population, African American men were most affected followed closely by Hispanic men. Heterosexual African American and transgender women from all ethnicities were also affected although disproportionately.
Interpretation of results regarding key health issue
Looking into the statistics provided by Centers for Disease control National HIV surveillance annual reports, the prevalence of HIV seems to be high between the people aged 18 years to 54. The possible explanation for this is that, this population is the one that is actively engaging in sexual activity. More specifically young adults between the age of 18 to 30 have a high prevalence of HIV infection. This is because, this is the population that mostly consists of people who are just beginning sexual relationships and are twice as likely to engage in unprotected sexual activity with multiple partners. This increases the chances of HIV acquisition and spread from infected to healthy persons.
Also, the youth and young adults normally engage in different social interactions guided by societal norms including going to parties and clubs. In such social events, it is common to indulge in consumption of drugs including alcohol and cannabis. The use of drugs is another trigger that increases the likelihood of contracting or spreading HIV. Drugs impair the ability of a person to make rational decisions. It therefore acts as a trigger for one to engage in risky sexual behavior that may result into contracting HIV. Also, some drugs like cocaine that are injectable increase the likelihood of spread of HIV. In the initial sections of the paper, it was described that one of the ways through its HIV can be contacted his through unhealthy practices like using needles that are not sterilized. Most of the people at parties or engaging in drug and substance abuse use needles that are shared without sterilization. This increases the likelihood of spreading HIV from infected to healthy persons.
Much of the population of New York state consists of those who do not have children. It is possible that such people either live as separated parents doing Co-parenting or without any marital status. As a result, the likelihood of such people having multiple sexual partners increases significantly and this explains the high numbers of HIV recorded in the state. Engaging in risky sexual behavior with multiple partners increases the likelihood of contracting HIV and AIDS. Most of the people who are in marriages are committed to one sexual partner unlike their counterparts that do not have marital commitment. As a result, the tendency of such people to engage in different sexual activities increases likelihood of contracting HIV and AIDS.
There has been high prevalence of HIV among African American and Hispanic men. This mostly affects homosexual men. HIV is spread through the exchange of body fluids mostly during sexual intercourse. The likelihood of African American and Hispanic men engaging in risky sexual behavior is increased as a result of the psychological trauma that people from such ethnicities have subjected to. It is possible that such traumas are the ones that propel them to engage in such risky behaviors that increase their likelihood of HIV and AIDS contraction. Also, the nature of the sexual intercourse that is performed most times without lubrication results into multiple entry points for the virus that increases chances of contracting HIV and AIDS.
The data also explains that heterosexual women of African American origin and other ethnicities are also vulnerable to HIV infections. This is because, such women face domestic violence that may include sexual harassment. Sexual harassment in the family context or among people who are in a casual relationship can result into acquisition of HIV and AIDS because of unprotected sexual intercourse. Other ways through which they can contract HIV and AIDS is through sexual harassment in the workplace that normally go unreported, cases of rape and other forms of sexual violence that such women are subjected to. Because of the trauma and victimization, and fear to go through when they report, such cases go unnoticed and can result into HIV acquisition without the knowledge of such parties.
The social economic status of a population also determines the spread of HIV and AIDS. People from low income communities that live below poverty levels lack basic information about how HIV and AIDS is acquired and spread. The lack of education means that such people engage in unprotected sexual activity because of ignorance. As such, this increases the likelihood of contracting the infection. Also, such people living below poverty lines do not have access to funds that they can use to purchase items like condoms that allow engagement in safe sexual intercourse. As a result, they would continue to use no protection thus increasing likelihood of contracting the virus. Much of the low-income societies also result to members having mental health disorders like depression that can lead such people to drugs and substance abuse. This will impair their judgment increasing chances of making wrong decisions like engaging in unprotected sexual intercourse with multiple partners thus contracting HIV. Finally, there are health disparities in people from low income societies such that they do not receive quality healthcare services. As a result, the prevalence of HIV among this population increases because of the fact that they are unable to receive health education on prevention and control of HIV and AIDS. Living conditions of such people also is poor and has been found out to be a factor that contributes to their inability to control the spread of HIV and AIDS.
Discussion of research gaps
The statistics that have been described in the previous sections of this paper do little to concentrate on identifying attitudes and behavioral intent of engaging in unprotected sexual intercourse. Much knowledge has been spread to the entire population in regard to how HIV is contracted and spread, and preventive measures. However, people still continue to engage in risky sexual activities that increases the chances of them contracting or spreading HIV and AIDS. Also, there is still a large number of the population that still does not know their HIV and AIDS status. Although the United States is one of the major funders of global response to human immunodeficiency virus, the country still has an ongoing epidemic of the same virus. Approximately 37, 600 new infections I recorded in the country each year (Miami Times, 2020). Although this is a small number compared to the general population of the country, it still represents a significant number and new strategies should be employed to ensure total control over the virus. Little research has been done to understand why certain people still engage in risky sexual behavior despite the knowledge of how such puts them at the risk of contracting the virus. Using the Theory of Planned Behavior, it is possible to understand the behavioral intent of such people towards engaging in sexual activities. With the knowledge of how societal factors affect the decision of a person to engaging unprotected sexual behavior or other triggers that may result into acquisition of the virus, the government can develop strategies to mitigate such triggers thus instilling positive sexual behavior among the target population that is the sexually active population between 18 and 54 years of age.
HIV and AIDS is a virus that affects human beings rendering it weak to infections and can result into death if untreated. Despite many strategies that have been put in place to ensure the control of the infection, there are still new diagnosis every year and the large portion of the population that lives with the infection without knowing. This epidemiological profile found out that some of the vulnerable groups in New York State and the United States in general include young adults, the sexually active population aged between 18 and 54 years, African American and Hispanic homosexual men, and heterosexual women from all ethnicities. With the understanding of how such populations are exposed to their vulnerabilities, it is possible to allocate funds and develop programs and campaigns to mitigate the triggers that may expose them to HIV. Also, it is important to understand some of the social triggers that guide the decision of people to engage into risky sexual behavior with an understanding of how it exposes them to risks of gaining infection. This will enable strategies to be developed to ensure infection prevention and control of HIV.
Miami Times (2020) 10 U.S. Cities with the highest HIV Rates. https://www.miamitimesonline.com/faith_family/10-u-s-cities-with-the-highest-hiv-rates/article_50471a7c-b634-11ea-8403-1727c08438e0.html
KFF (2020) New York: Categories and Indicators. Retrieved from https://www.kff.org/statedata/?state=ny
CDC (2020) Statistics Center. Retrieved from https://www.cdc.gov/hiv/statistics/index.html
CDC. (2019, November 21). Statistics Overview. Retrieved from
CDC. (2019, December 2). About HIV/AIDS. Retrieved from https://www.cdc.gov/hiv/basics/whatishiv.html