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Health Impact Final Paper

HIV/ AIDS in South Africa
Morgan Waide
Delaware Technical Community College
NUR 310-203 Global Health
Mrs. Maloney
February 23rd, 2024
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Introduction

Martin Luther once said, “Of all the forms of inequality, injustice in health is the most shocking

and inhumane”. Many countries and regions face this issue of not having access to adequate and proper

healthcare. One of those regions is the South Sudan of Africa, one of the main issues that they face is the

HIV/AIDS problem that the woman and children suffer from. By definition HIV/AIDS is a lifelong

illness“ HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If HIV is

not treated, it can lead to AIDS (acquired immunodeficiency syndrome” (CDC, 2022). To add on top of

this they have limited access and help from the government to help aid in the fight and treatment against

the disease. With the nursing profession it is our duty to the public and our patients to recognize help

where it is needed and provide it so that way patients can be treated properly and the way they are meant

to be. There are too many injustices with the healthcare system not just in the United States but globally

that need to be addressed.

Health Impact Pyramid

To understand the true impact injustices of inequalities that the people of South Africa face, the

health impact pyramid give a glimpse to the different components that are apart of the problem. The

National Library of Medicine define the Health impact pyramid as “A 5-tier pyramid best describes the

impact of different types of public health interventions and provides a framework to improve health. At

the base of this pyramid, indicating interventions with the greatest potential impact, are efforts to address

socioeconomic determinants of health. In ascending order are interventions that change the context to

make individuals' default decisions healthy, clinical interventions that require limited contact but confer

long-term protection, ongoing direct clinical care, and health education and counseling” (Friedan, 2010).

Having the different stages of the pyramids helps professionals with the appropriate resources that are

needed and where they are needed. Having interventions “that address social determinants of health have

the greatest potential public health benefit. Action on these issues needs the support of government and

civil society if it is to be successful. that address social determinants of health have the greatest potential
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public health benefit. Action on these issues needs the support of government and civil society if it is to

be successful” (Friedan, 2010). The purpose of the pyramid is to get the interventions out there to help the

civilians in any way that is possible.

Factors of The Pyramid

There are 5 different sections within the Health Impact Pyramid, the bottom of the pyramid is

socioeconomic, next is changing the context of one's health, the third tier is long-lasting interventions, the

fourth tier is the clinical interventions, and finally the top tier is counseling and education. For the

socioeconomic tier of the pyramid and how it applies to the region of South Africa and the HIV/AIDS

health problem, researchers have found that the region alone has almost twice the national average of

HIV/AIDS cases. There are different determinants that can cause an increase like age, sex, behavior

factors, and availability for testing. Another researcher found that social economic factors are reasons that

people of South Africa are more exposed to HIV “yet, it remains unclear how socioeconomic factors

impact the risk of HIV infection within township populations. Our objective was to estimate the extent to

which socioeconomic factors (dwelling situation, education, employment status, and monthly income)

explain the risk of HIV in South African township populations, after controlling for behavioral and

individual risk factors” (Soo, 2023). Not only that, but the topic of HIV and AIDS is a sensitive topic, yes

it is being talked about but there is still a stigma around the disease and not enough education or access to

help prevent the spread of the disease.

The second tier of the pyramid is summary called burden of the disease, which by definition

means “The Global Burden of disease (GBD) study provides a comprehensive picture of mortality and

disability across countries, time, age and sex. It quantifies health loss from hundreds of diseases, injuries,

and risk factors, so that health systems can be improved, and disparities eliminated” (IHME, 2023). The

burden of this specific disease is huge as mentioned before having twice the rate then the average, in 2022

alone the World Health Organization found that 39 million people alone were living with disease, South

Africa makes up a big part of that number “The WHO African Region remains most severely affected,

with nearly 1 in every 25 adults (3.2% living with HIV and accounting for more than two-thirds of the
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people living with HIV worldwide” (WHO, 2022). The people of South Africa face a huge disadvantage

with disease as one of areas it affects the most, the people are not receiving the proper healthcare, and

treatment which is apart of interventions that are needed to stop the spread.

The third and fourth tier of the Health Impact Pyramid go together with having clinical

interventions you receive a long-lasting intervention. Now as nurses we use interventions everyday to

help treat disease processes to help prevent patients from coming back to the hospital. Many of these

patients in South Africa do not have the same access to medical treatment as other countries do. One of

the top interventions that we can provide is getting tested as early as possible and educating on preventing

the spread of the disease. Some other interventions that help combat the disease is “the US President’s

Emergency Plan for AIDS Relief (PEPFAR) estimates that in the past three decades, access to HIV

treatment has averted about 20.8 million AIDS-related deaths worldwide. PEPFAR is a funding

organization initiated by the US government to combat the global HIV/AIDS epidemic. It was launched

by President George W. Bush in 2003 and has been a significant contributor to the international effort to

prevent and treat HIV/AIDS. PEPFAR provides financial support to countries heavily impacted by the

HIV/AIDS epidemic, aiming to improve access to prevention, care, and treatment services” (Kumah,

2023). Besides the epidemic of HIV, the people of South Africa face other health issues because of the

mistreatment of there land like deforestation which leads to lack of oxygen and more of air pollution,

when you add more health issues to an already serious medical condition it can be a hard road for the

patient to recovery from. By putting in interventions like the US like getting financial support or getting

treatment makes all the difference when patients can’t get what they need to thrive.

Finally, and most importantly is the continuing education, as a nurse and in the nursing profession

on top of the interventions that we perform. One of the main ones that would help with the environment

especially dealing with global issues is becoming politically active and advocating for better access to

healthcare. By being politically active you are able to present current issues to the public and get it

attention so that way it doesn’t get pushed aside and the problem becomes worse.
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Nursing and Global Health

“Every nurse was drawn to nursing because of a desire to care, to serve, or to help” (Feist-

Heilmeier, 2020). As a nurse it is upmost duty to advocate, care for and help our patients not only in a

hospital setting but, in our communities, and across the globe. As nurses we are able to go out into

different communities and can provide aide where other people can not, we have the training and

education that the civilians of that region do not have. When we are able to go out in the world and our

“role is to promote preventive health measures, educate individuals and communities about healthy

lifestyle choices, and conduct research to find methods to stop the spread of disease. Global health nurses

must also recognize and take into consideration the social determinants of health on a population”

(Tamiu, 2020). Certain organizations help us do that, where we can go to certain underdeveloped

countries like South Africa and provide care to sick patients, patients that have diseases like HIV and

AIDS. The National Library of Medicine wrote an article regarding the outlook of nursing and its impact

on global health “Thinking globally is not an academic exercise but a way of seeing that enriches

perspectives, increases knowledge, and makes nurses more motivated and effective as leaders,

practitioners, managers, teachers, researchers, policymakers and activists. It helps us to understand how

our work contributes to outcomes not only in health sectors, but also in policy, education, economic

relations, and environmental activism. Nurses have a professional obligation to understand the world in

its broader context and base decision-making on an expanded understanding of ourselves, our patients,

and our circumstances” (Salvage, 2022). When we branch out and see things that we normally wouldn’t it

helps shape us and change our outlook on nursing and what got us into and by going out globally will

help us as nurses not only learn as a nurse but as a human.

Cultural Beliefs
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In nursing we see and deal with patients that come from different cultural backgrounds that are

different from ours. The South African culture “families are generally affectionate, protective, and

expressive. Politeness is an important aspect of South African culture. Religion plays a significant role in

most South African families and attendance at some form of religious gathering is very common on a

weekly basis. South African families tend to be small and close-knit, though some may live with extended

family members” (AFS, 2024). The African culture is a close-knit community especially if you live in a

tribal region. One of the reasons that health disparity is a major concern in South Africa is that “It is not

uncommon for people to believe that the cause of their illnesses is a result of curses or punishment from a

deity or witchcraft. Individuals may also prefer care from non-medical providers who are part of their

culture, speak their language and understand the social issues related to their illnesses. Thus, many people

Trust cures that are socially or spiritually linked such as traditional herbs, incantation, prayers, or

soothsaying” (Joe, 2022). Because this culture doesn’t necessary believe in medical treatment from

healthcare providers it is harder to treat and get proper education to the people who are sick, and that

makes the job harder. But as nurses we need to try and understand there culture to try and help better

understand each other in a respectful way.

Conclusion

In conclusion, Martin Luther was right in that the inequality deals with our health. Not everyone

has the same access to treatments as other people do. Southern Africa faces many troubles from the

HIV/AIDS epidemic that they face daily with increasing number but also the other environmental

problems they face which makes there diseases harder to treat. As nurses it is our duty to step up and put

in action ways to help the people, whether it is becoming politically active to get the health issues

acknowledged or going out globally and help educate and provide treatment for these patients so that way

they have long lasting interventions for there health. By diversing ourselves and learning from other
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cultures it helps us as nurses treat patients in the way they deserve to be treated either in the hospital or in

the community.
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