Epidemiology Paper Essay

Human Immunodeficiency Virus (HIV) is a virus that only affects humans, HIV weakens your immune system by destroying the cells that fight and kill disease and infections. HIV reproduces by taking over cells in the host’s body and multiplying, with most viruses over time the immune system can rid the body of the present virus, with HIV the immune system is incapable of doing this, therefore it is a virus that will always be present once infected.

HIV is spread through bodily fluids such as blood, seamen, rectal fluids, vaginal fluids, and breast milk. In order for HIV to be transmitted via bodily fluids it “must come into contact with a mucous membrane or damaged tissue or be directly injected into your bloodstream (by a needle or syringe) for transmission to possibly occur.” (What is HIV/AIDS? 2014) Mucous membranes is the soft moist tissues around areas that openings to the body, such as the mouth, opening of the rectum, vaginal cavity, and opening of the penis.

The most common way HIV is transmitted is through unprotected sex with anal sex being the highest sexual risk. Other means of transmission is blood infusions, IV drug use, needle sticks (mainly a risk for health care workers), transmission from mother to infant, or direct contact with broken skin. There has been many myths on how HIV can be transmitted, it is important to know facts versus myths. Some common myths on transmission are HIV can be transmitted via touching, saliva, tears, sweat, air, water, and toilet seats. Once the virus is outside the body it doesn’t survive for long.

HIV weakens your immune system making infection the largest complication of the virus. The most common infections are tuberculosis, Salmonellosis, which is why all food needs to be clean thoroughly and cooked well, individuals infected with HIV should try to stay away from eating fresh fruit and vegetables when possible. Other illnesses include Cytomegalovirus, Candidiasis, Cryptococcal meningitis, Toxoplasmosis, and Cryptosporidiosis. Other illnesses are common to HIV infected individuals with the most common being Kaposi’s sarcoma and cancer that normally appears as pink, red, or purple lesions around the mouth or on the skin, this type of cancer can also affect organs including the digestive track or lungs. You may also see wasting syndrome, neurological complications, and kidney disease. (Mayo Clinic 2014)

Symptoms of HIV vary by individual, but normally appear as flu like symptoms one to two months after the virus has infected the body. These symptoms include fever, chills, cough, headache, rash, sore throat, mouth or genital ulcers, swollen lymph nodes, night sweats, and diarrhea. At times the primary symptoms may be mild and go unnoticed as the disease progresses individuals may experience shortness of breath, fatigue, and weight loss. This stage of the disease is referred to as HIV and lasts anywhere from 8-10 years, with advancements in treatment in may last even longer. The last stage of the virus, AIDS (acquired immune deficiency syndrome) happens when the body’s immune system has been severely damaged causing the person to be highly susceptible to opportunistic infections.

While there is no cure for the HIV virus there are medications to manage the virus and slow its progression. The classification of medications used is anti-viral medications, which include: Non-nucleoside reverse transcriptase inhibitors (NNRTIs), they disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune). Nucleoside reverse transcriptase inhibitors (NRTIs) are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir). Protease inhibitors (PIs) disable protease, another protein that HIV needs to make copies of itself.

Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir). Entry or fusion inhibitor drugs block HIV’s entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells. (Mayo Clinic 2014) Treatment with theses medications can be difficult they cause nausea and vomiting, heart disease, weakening of the bones, and rashes. After starting these medications your physician will monitor how well they are working and make changes as needed.

The HIV virus is incurable the CDC estimates that 1,144,500 persons aged 13 years and older are living with the HIV infection, including 180,900 who are unaware of their infection. (CDC 2014) There is an estimated 50,000 new cases in the US yearly and an estimated 15,000 deaths per year. Of the one million diagnosed with HIV an estimated 600,000 have AIDS. While this virus in incurable and considered to most as a death sentence advancements are made daily with medication and the life span after diagnosis has greatly increased, in 1996 life expectancy was 36.1 years and in 2005 it had increased 13 years to 49.4 years. (Science-Based Medicine, 2013) These advancements can only continue to climb in the future.

Addressing individual’s determinants of health and how it relates to HIV is vital in disease prevention. While HIV can affect anyone regardless of ethnicity, social status, or income level it has a higher prevalence in lower social economic status. Individuals who live in poorer communities are at a higher risk for contracting HIV, with lower income comes lower education rates and decreased available resources. It is imperative as nurses that we are continually providing education and the means for sexual protection or the availability for help with substance abuse. The more education that can be provided the greater chances there is in decreasing transmission rates.

Understanding the epidemiologic triangle of HIV can help to determine who is at risk and how to prevent that risk. The triangle consists of three sections: the host, which includes the person and factors that may put them at risk like age, sex, genetic profile, occupation, marital status, and religious practices. The second part is the environment, a person’s living situation, what type of community they belong to, or if all of their human needs are being met such as food and safety. The third section is the agent, this pertains to what is needed to make the infection occur, risks such as unprotected sex or IV drug use would qualify as the agent in regards to the transmission of the virus. By understanding how a individuals fit into this triangle we can help to better educate them and provide the needed education and resources to aid in transmission prevention.

It is the role of the community nurse to access the community and patients as individuals and determine the risk factors if any and needs. Upon assessment there should be the formulation of a plan of care to help in determining the steps needed for health promotion and prevention of HIV. If an individual is at risk for HIV proper testing should be implemented to find out if they are positive or not, this requires a consent from the patient in California. When there is a positive result for HIV a second test is performed, when that test is positive there is mandatory reporting to the state, this reporting does not include personal information of the patient.

Mandatory reporting helps to analyze the rate of HIV diagnosis and what populations are affected more then others. Follow-up of patients diagnosed with HIV is imperative in their care; this is a life changing catastrophic diagnosis, its something that can cause loss of hope and depression. Newly diagnosed HIV patients should be offered counseling, resources within the community to help them cope with this new diagnosis, and follow-up calls or visits to address any concerns they may have. Along with the diagnosis comes learning how to live in a new way, they must be conscious of illness in the community so they do not acquire any other diseases or viruses, and they must also be conscious and well educated on how to prevent the spread of HIV.

Over the recent decades the spread of HIV has declined, but that is not enough with the deadly outcome it poses. As nurses we need to recognize a person’s risk to the virus and ways we can break the chain of infection. Through education, health promotions, and utilizing community resources hopefully the decline in HIV diagnoses can continue to fall with someday eradicating the virus totally.


What is HIV/AIDS? (2014). Retrieved September 28, 2014, from http://www.aids.gov/hiv-aids-basics/

HIV/AIDS. (2014). Retrieved September 28, 2014, from http://www.mayoclinic.org/diseases-conditions/hivaids/basics/complications/con-20013732

HIV in the United States. (2013, December 3). Retrieved September 28, 2014, from http://www.cdc.gov/hiv/statistics/basics/ataglance.html

HIV Treatment Extends Life Expectancy « Science-Based Medicine. (2013, January 1). Retrieved September 28, 2014, from http://www.sciencebasedmedicine.org/hiv-treatment-extends-life-expectancy/This will paper discuss one of the deadly disease in the world call Tuberculosis (TB). The goal is to prevent the disease and prevent the spread of the disease from the teaching that the community health nurse will provide. An individual can die if TB is left untreated.

Active Tuberculosis

Tuberculosis (TB) is an infection caused by a bacteria called Mycobacterium Tuberculosis. This respiratory disease that in most common in the lungs. (World Health Organization, 2014). Other parts of the body are affected by TB is the brain which causes tuberculosis meningitis, genitourinary TB, gastrointestinal TB, tuberculosis lymphadenitis, cutaneous TB, Uterus ovarian TB and Osteo articular skeletal bone and joint TB(articles base, 2008). It is curable and preventable. TB is contagious and is transmitted through the air from a person with the active respiratory disease and then another person inhale this infectious droplet.

Active TB symptom from the lung are coughing, and with bloody sputum present sometimes, weakness, chest pain, fever, weight loss and night sweats. Once the germs enter the air it takes only a few of them to infect another person (World Health Organization, 2014). People with active TB usually have positive TB skin test and blood test. The chest x-ray is usually positive and positive sputum culture (Centered for Disease Control and Prevention, 2012).

Latent Tuberculosis

Another form of TB is called Latent TB infection. This TB have bacteria that can lay dormant in a person body and not make them sick. The individual with this TB are without symptom and are not infected and therefore not able to transmit this disease to someone else. But if the bacteria become active and multiply, then a person will develop the TB disease. Also if the immune system is weak and the person is not able to fight off the infection, the individual will develop the active disease, become sick and spread the bacteria to others. There are lots of people with Latent TB that never develop the infectious TB disease.

About 5 to 10 percent of these people will develop the TB disease at some time of their life. Usually a TB skin test or blood test will show the TB infection, but the chest x-ray and sputum culture is normal. . People with HIV/AIDS are at greater risk for developing TB due to a weak immune system (Centered for Disease Control and Prevention, 2012).

Treatment for Active Tuberculosis and Latent Tuberculosis

Active TB treatment consist multiple antibiotic being given simultaneously for at least six month to cure the disease. The regimen is four antibiotic for the first two months and then decreased to two antibiotics for the last two months. Most of the antibiotics are given in pill form. The antibiotics of choice are listed in generic form as follow, ethambutol, Isoniazid, pyrazinamide, rifampin, cycloserine, ethionamide, levofloxacin, moxifloxacin, para- aminosalicylic acid, and streptomycin. Sometimes steroids medication are used if inflammation is present. But the medicine has to be taken as prescribed. If doses of medication are missed this can cause a delay in curing the disease. (Everyday health, 2014). The Latent TB treatment consist of the antibiotic isoniazid for six to twelve months to prevent the TB disease from progressing to an active status for most people.

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But also taking a mixture of two antibiotics for 3 months is a good way to treat latent TB, but a health care provider has to monitor the person taking the medication in order to prevent the latent TB from becoming active due to a person missing medications (Everyday Health, 2014). “There are special treatment recommendations for people with HIV and TB, people with drug resistant TB, children with active TB and pregnant women with active TB” (Everyday Health, 2014).

Complications of TB Treatment

A person lung can become permanently damage if the treatment are not started early. Difficulty in breathing can developed, the infection can travel to other organs in the body and also the infectious disease can developed a resistance to the medications. A person not taking their medicine as prescribe can cause a resistance to the medications and make the disease tougher to cure (Rodriquez, 2014). There has been an escalation in the resistance of TB drugs that has been used for years. This resistance has affected every country that has been surveyed. Multidrug-resistant tuberculosis (MDR-TB) happens when the top two medication, Isoniazid and Rifampicin are taken and the bacteria does not respond to medication. The main reason for MDR-TB is in the wrong form of treatment or the drug is not used correctly and often the drug is of poor quality. It is treatable and curable but is more expensive. When the extensive chemotherapy is used in the treatment of MDR-TB, it takes up to two years to treat the disease and can cause a severe reaction in a person (World Health Organization, 2014).

Tuberculosis can be misdiagnosed because the symptoms may be the same symptoms of other diseases. It is vital to take a good health history and physical examination. Taking a blood test and Tuberculin skin test can determine if the person has been infected or exposed to active TB. A chest X-ray is needed to see lesions on the lungs that is caused by tuberculosis. A sputum sample is obtained to confirm the present of the TB bacteria (Centered for Disease Control and Prevention, 2012). Some people has to be admitted into the hospital and placed in a special room that filters out TB bacteria out of the air. This will prevent health care workers and other people in the hospital from contracting the TB infection. It is likely that a person is not to leave the room until 3 sputum samples are obtained and shows that a person can no longer spread the infection (Everyday Health, 2014). Also the side effect of the strong drugs use has to be monitor. Some drugs can cause the liver to become inflamed, kidney and nerve damage and changes in vision. Death can occur if TB is not treated and cured (Rodriquez, 2014).

Demographics and Health Statistics

“Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent” (World Health Organization, 2014). There were about 8.6 million people in 2012 that contracted TB and 1.3 million deceased from TB. Around 95% of these death happen in the low class and middle class income countries. TB is around the third cause of death in women age 15 to 44. About 530,000 children contracted the TB in 2012 and 74,000 HIV negative children deceased from TB. One fifth of people that has HIV deceased from TB which is the number one killer for them. The Millennium Developmental Goal for 2015 is to overturn the spread of TB, which as of now the number of people contracting TB decreasing each year but very slowly. TB death rate declined by 45% between 1990 and 2012 (World Health Organization, 2014).

Epidemiology Triangle of Tuberculosis

Host Factor of Tuberculosis consist of the age, ethnic background, race, education and economic status. This describe the host or the person that is affected by the disease and what made the individual more acceptable to contact TB. It could be a mixture of many reasons, like chronic illness, weak immune systems or a recurrent TB or other diseases (Maurer & Smith 2009). The Agent Factor of Tuberculosis is a bacteria known as Mycobacterium Tuberculosis that is transmitted through the air from respiratory droplets (World Health Organization, 2014). The Environment contains the air, family, community, public policy, and workplace, economic status, housing population, and culture and health services. All of these can affect the person before and after TB is contracted. The person living in a crowed population is most at risk of being exposed to TB. The family and the community is at risk for receiving and spreading TB. If the public does not have a policy to protect individuals, put them at a high risk. The individual’s is affected by their attitude, health practices, no insurance, and not able to obtain proper health care (Maurer & Smith 2009).

Roles of the Community Health Nurse

The Community Health nurse is responsible for assessing the community for communicable diseases and needs of the community and start the process and report findings to the appropriate person or group. The nurse take on the role as the teacher, educator, and counselor. It is important for the nurse to help prevent the spread of disease and illness in the community by providing education. The health and social needs are to be assessed. The nurse is knowledgeable of infectious diseases and familiar with epidemiologic data in order to assess the needs and problems in a given community. The nursing process must be used with the principles of epidemiology in order to provide the appropriate care.

Educating the community in regard to communicable disease such as the risk factors, prevention and how they are transmitted and importance of good hygiene. Follow-up care is needed to assess and measure the outcome of the community. The nurse should work with other health care worker motivates changes in health behavior in individuals, families, groups, and communities that also include lifestyle in order to promote and maintain health (RN pedia.com, 2014).

National Agency

Centers for Disease Control and Prevention (CDC) has been dedicated to protecting health and promoting quality of life through the prevention and control of disease, injury, and disability. CDC is always working seven days a week and twenty four hours a day to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or in the community, the disease can be chronic or acute, curable or preventable, the CDC fights disease and supports communities and saves patient lives (Centered for Disease Control and Prevention, 2014).


Tuberculosis is a deadly disease. It is preventable and curable. Millions of people contract this disease and millions of people die from this disease yearly. Teaching from the nurse to the community is very important to prevent the disease and prevent the spreading the disease. Nurse are to be knowledgeable themselves of the disease and help in promoting and keeping the community healthy.


World Health Organization. (2014). Tuberculosis (TB). Health Topic. Retrieved from http://www.who.int/topics/tuberculosis/en/ World Health Organization. (2014). Tuberculosis. Fact Sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs104/en/

Articles base. (2008). Other or Different Types of Tuberculosis? Retrieved from http://www.articlesbase.com/diseases-and-conditions-articles/other-or-different-types-of-tuberculosis-474213.html Centered for Disease Control and Prevention. (2012). The Difference between latent TB infection and The TB disease? Facts Sheets. Retrieved. http://www.cdc.gov/tb/publications/factsheets/general/LTBIandActiveTB.htm

Rodriquez, D. (2014).Monitoring Tuberculosis Treatments. Everyday Health. Retrieving from http://www.everydayhealth.com/tuberculosis/monitoring-tuberculosis-treatment.aspx Everyday Health. (2014). Multiple Drug Therapy for Tuberculosis. Retrieved from

http://www.everydayhealth.com/health-center/multiple-drug-therapy-for-tuberculosis-tb.aspx#hw20716 Maurer, F. A., & Smith, C. M. (2009). Community/Public health nursing practice: Health for families and populations (4thed.). St. Louis, MO: Saunders/Elsevier. RN pedia.com. (2014). Community Health Nurse Roles and Functions. Retrieved from http://www.rnpedia.com/home/notes/community-health-nursing-notes/community-health-nurse-roles-and-functions

Centered for Disease Control and Prevention. (2014). CDC Organization .CDC 24/7: Saving Lives and Protecting Peoples. Retrieved from http://www.cdc.gov/about/organization/cio.htm”Epidemiology today is considered to be the core science of public health and is described as a constellation of disciplines with a common mission: optimal health for the whole community” (Stanhope & Lancaster, 2008). Epidemiology continues to play a large role in public health to improve on disease prevention and health promotion in communities across the United States and the World. The Gay, Lesbian, and Bi-sexual and Transgender (GLBT) community at it relates to HIV will be the main focus of this epidemiology paper. This paper will focus on the GBLT population in regards to their vulnerability and susceptibility to HIV, along with the epidemiology and levels of prevention. The following paper will discuss the definition and purpose of epidemiology, methods of epidemiology, the epidemiology triangle, as well as the levels of prevention that relate to HIV ethical and legal considerations, cultural considerations on health status, and how characteristics influence vulnerability in the GBLT community.

According to Ard & Makadon, “Not only are lesbians, gay men, bisexual women and men, and transgender people distinct populations, but each of these groups is itself a diverse population whose members vary widely in age, race and ethnicity, geographic location, social background, religiosity, and other demographic characteristics.” In the past GLBT community was more accepted in San Francisco and New York, and with more people “coming out,” the GLBT population has become more publically recognized across the United States. According to an NIBC article the phrase “lesbian, gay, bisexual, and transgender community refers to a broad coalition of groups that are diverse with respect to gender sexual orientation, race/ethnicity and socioeconomic status.” The GLBT is a different population, but they are very diverse in race, age, location and social backgrounds. Location is one of the biggest differences due to it being easier to express your orientation in a larger city. In rural areas, the GLBT people may feel more uncomfortable coming out due to fewer support services.

With the GLBT population, the most prevalent epidemiology is HIV/AIDS. First we need to know the definition of epidemiology. Merriam-Webster Dictionary defines Epidemiology as “Study of disease distribution in populations. It focuses on groups rather than individuals and often takes a historical perspective. Descriptive epidemiology studies a population to see what segments (e.g., age, sex, ethnic group, occupation) are affected by the disorder, follows changes or variations in its incidence or mortality over time and in different locations, and helps identify syndromes or suggest associations with risk factors. Analytic epidemiology conducts studies to test the conclusions of descriptive surveys or laboratory observations. Epidemiologic data on diseases is used to find those at high risk, identify causes and take preventive measures, and plan new health services.” HIV the most common disease within the GBLT community but it is more prevalent within gay and bisexual men. HIV is a sexually transmitted infection that is transmitted through body fluids and blood.

According to the Mayo Clinic, HIV/AIDS is described as “AIDS (acquired immunodeficiency syndrome) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body’s ability to fight the organisms that cause disease. HIV is a sexually transmitted infection. It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. It can take years before HIV weakens your immune system to the point that you have AIDS. There’s no cure for HIV/AIDS, but there are medications that can dramatically slow disease progression.” HIV is transmitted in five ways: through unprotected sexual intercourse, transmission of contaminated blood, sharing of contaminated needles, mother to child during breastfeeding. Contrary to popular belief, HIV cannot be transmitted through kissing, hugging or shaking hands. In addition, sharing eating utensils or bathroom facilities, does not transmit HIV.

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The only absolute sure way not to contract HIV is 100% abstinence but it is not for everyone. The community health nurse role is crucial, they must have a full spectrum of understanding the HIV virus. When a patient comes in for testing, the nurse must understand their fears and offer emotional and psychosocial support. To better understand the disease works we need the Epidemiological Triangle that is “disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements, the agent, host, and an environment, are traditionally referred to as the epidemiologic triangle. This model, originally developed as a way of identifying causative factors, transmission, and risk related to infectious diseases. Changes in one of the parts of the triangle can influence the occurrence of disease by increasing or decreasing a person’s risk for disease. Specific characteristics of agent and host, as well as the interactions between agent and host, are influenced by the environmental context in which they exist, and may in turn influence the environment” Stanhope & Lancaster, (2012).

The Epidemiologic Triangle describes the potential imbalance of health. The agent is the HIV virus, and the host is human interaction such as race and education, and the environment represents the risky behavior such as unprotected sex or sex with multiple partners. Quantitative and qualitative is used to evaluate community interventions. The community nurse must have a full spectrum and understanding of HIV. The primary importance of the community health nurse and the Epidemiology Triangle is education thru prevention. According to the Stop HIV website, there is a primary and secondary prevention, “Primary Prevention: Preventing an individual from becoming infected with HIV. Secondary Prevention: Once a person is infected with HIV, assisting the person in staying healthy as long as possible and not developing complications.” In the primary prevention stage, individuals are taught how better to protect themselves against HIV and other sexually transmitted diseases. The use of condoms and monogamy is two of the easiest ways to prevent the spread of HIV among the GBLT populations.

The secondary prevention is actually to use the techniques they learn in the primary prevention. According to the CDC ” Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet are the population most severely affected by HIV. In 2010, young gay and bisexual men (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all gay and bisexual men. At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States were gay and bisexual men, or gay and bisexual men who also inject drugs.” Some characteristics with the population that may affect their vulnerability would include promiscuity among bisexual men, overtly effeminate, and the differences within the population. Bisexual men are more likely to have unprotected and infect their female partner without her knowing.

By being very feminine in public, opens them up to bullying and discrimination. With differences among the population varies from open public affection to still remaining in the closet, and same partner violence among lesbians. “About 17-45% of lesbians report having been the victim of a least one act of physical violence perpetrated by a lesbian partner and sexual abuse by a woman partner has been reported by up to 50% of lesbians” (Suzana Rose, Ph.D.). Health People 2020 reports that “Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons have been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals.” Insurance is a significant problem with same sex partners because many companies do not recognize them, and they are not able to able to be placed on their partner’s insurance.

Having no medical insurance makes it hard to provide medicines that are needed to help keep HIV from turning into AIDS. There is a need for more LGBT health centers and the expansion of insurance coverage to include domestic partners of the same sex. Doctors must be informed about LGBT health issues due to biases in health care despite the communities growing acceptance of the homosexual population lifestyles. Second, although there are no specific diseases that affect only the LGBT health because of various health disparities. These disparities include a lack of culturally competent health care, legal factors and social discriminations. The LGBT community faces discrimination, biases, and legal issues every day, but the Transgender population feels it more. According to the ACLU “Much of the discrimination transgender people face mirrors that experienced by lesbian, gay, and bisexual people, but is often more severe.

Additionally, transgender people face a range of legal issues the LGB people rarely do. Identity documents are not reflecting ones gender.” Not only do they have a problem with their identification papers but there is the problem of public restrooms. Which restroom would one use if their transition has not been completed? One of the biggest legal issues in most states is same sex marriages and same sex domestic partnerships. Same sex marriages are not recognized and this leaves the one partner’s unable to be the next of kin in order to make medical decisions. One ethical issue would be the development of a vaccine that must be tested on HIV in different stages. And if the vaccine is developed, who would be able to afford the medication. How would third world countries such as Africa where HIV and AIDS are prevalent be able to afford it? With society taking significant steps toward accepting current views on sexuality, we have begun to remove the stigma that have been associated with being gay, lesbian, bisexual or transgender for many years.

Accepting lesbian, gay, transgender and bisexual orientations, behaviors, relationships, lifestyles and same sex marriages may also remove any biases. In conclusion, Epidemiology is everywhere in today’s society. HIV is one disease that is most associated with the GLBT population. Because of this there still the stigma that if you are homosexual that you have HIV/AIDS. With education of the GLBT population as well as other populations on how HIV is spread and can be prevented, we can break the epidemiological triangle at the host point.

The break in the triangle is completed by primary and secondary prevention of education on preventing the spread of the disease itself. We also discussed some legal and ethical issues that the GLBT population face every day. Over the years many psychologists, behavioral scientists, and community health nurses have made great strides in changing the community views of homosexuality, recognize the legitimacy of gay male, lesbian, bisexual, and transgender behaviors, relationships and lifestyles in today’s society. Until biases are removed there with always be some kind of legal and ethical issues dealing with HIV and AIDS among the Gay, Lesbian, Bisexual, and Transgender population.


American Civil Liberties Union: Discrimination against Transgender People Retrieved June 11, 2014 from


Center for Disease Control and Prevention Fact Sheet

Retrieved June 12, 2012 from:


Healthy People 2020


Lesbian Partner Violence Fact Sheet Suzana Rose, Ph.D. National Violence against Women Prevention Research Center University of Missouri at St. Louis Retrieved June 14, 2014 from:


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Epidemiology Paper Essay

“Tuberculosis (TB), a multisystem disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. TB is caused by M tuberculosis, a slow-growing obligate aerobe and a facultative intracellular parasite. The organism grows in parallel groups called cords (as seen in the image below). It retains many stains after discoloration with acid-alcohol, which is the basis of the acid-fast stains used for pathologic identification.

Humans are the only known reservoir for M tuberculosis. The organism is spread primarily as an airborne aerosol from an individual who is in the infectious stage of TB (although transdermal and GI transmission have been reported). Classic clinical features associated with active pulmonary TB are as follows: cough, weight loss/anorexia, fever, night sweats, hemoptysis, chest pain, and fatigue. For initial empiric treatment of TB, patients are started on a 4-drug regimen: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Once the TB isolate is known to be fully susceptible, ethambutol (or streptomycin, if it is used as a fourth drug) can be discontinued” (Herchline, 2014).

“Tuberculosis (TB) is one of the world’s deadliest diseases: 1) One third of the world’s population is infected with TB, 2) In 2012, nearly 9 million people around the world became sick with TB disease. There were around 1.3 million TB-related deaths worldwide, 3) TB is a leading killer of people who are HIV infected. A total of 9,582 TB cases (a rate of 3.0 cases per 100,000 persons) were reported in the United States in 2013. Both the number of TB cases reported and the case rate decreased; this represents a 5.4% and 6.1% decline, respectively, compared to 2012” (cdc.gov, 2014).

The Commission on Social Determinants of Health identifies social determinants of health as conditions that make social stratification recognizable in the society. The following are structural determinants of the epidemiology of tuberculosis: fast urbanization and growth of population, global socioeconomic inequalities, and elevated levels of population mobility. The said conditions are the causes of unequal distributions of the key social determinants of TB which are poor housing and environmental conditions, food insecurity and malnutrition, and geographical, cultural and financial barriers to accessing healthcare. As a result, the distribution of population of TB mirrors the social determinants distribution, which, in turn, imposes an effect on the four stages of TB pathogenesis: “exposure to infection, progression to disease, late or inappropriate diagnosis and treatment, and poor treatment adherence and success” (Hargreaves, et al, 2011).

The social determinants mentioned above are key risk factors for TB. As an example, overcrowded homes, workplaces and communities, and poor ventilation increase the risk of non-infected persons getting exposure to TB infection. Other factors that could increase susceptibility to TB infection are malnutrition, hunger, and poverty. In addition, these also affect the severity of the clinical outcome of the disease. “Individuals with TB symptoms such as a persistent cough often face significant social and economic barriers that delay their contact with health systems in which an appropriate diagnosis might be made, including difficulties in transport to health facilities, fear of stigmatization if they seek a TB diagnosis, and lack of social support to seek care when they fall sick” (Hargreaves, et al, 2011).

The epidemiologic triangle is a medical tool that is composed of an agent, host, and an environment. This is utilized to explain how a disease spreads throughout the environment, to define the points of intervention in order to prevent transmission, and to provide guidance to investigations in epidemiology. (McMurray, 2007). “The agent in this study is Mycobacterium tuberculosis, an acid fast aerobic rod that reproduces slowly and is hypersensitive to heat and ultraviolet light. TB primarily affects the respiratory system; however, it can also affect the pericardium, lymph nodes, meninges, kidneys, intestines, bones, joints, and reproductive organs” (The Merck Manual, 2014).

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“The transmission of the Mycobacterium tuberculosis is spread from person to person via airborne droplets through actions such as coughing, talking and sneezing. The smaller the droplet, the longer it can stay in the air after the infected person has left the area. This causes an increase in the probability of inhalation by another individual. Passing TB from a family member or co-worker is more likely than a stranger in a store or on the streets”. (Reichler et. al, 2002).

Mycobacterium tuberculosis, the infectious disease agent, is readily transmitted to susceptible humans, the host, through respiratory exposure in communal settings or public gatherings, the environment. Individuals with compromised immune systems, such as cancer, being on corticosteroid therapy, and HIV/AIDS, are at greatest risk for getting TB infection. Healthcare workers are continuously exposed to illnesses at the hospitals and long term care facilities, which puts them at risk for TB. “Early detection and treatment of the actively infected person is the key to prevention of transmission of tuberculosis in the healthcare setting” (Smeltzer et. al, 2004).

Nurses are the backbone of TB control. The public health nurse’s role in TB management not only involves management services required for patient care and treatment, but also includes an array of public health activities to assist in preventing and controlling the spread of disease in the community, which is the ultimate goal of TB nurse management. The first domain of community health nursing is assessment and analytical skills. The nurse must possess the essential background knowledge and skills such as state and local demographic profile, TB epidemiology, modes of TB transmission, testing and diagnosis of TB, BCG vaccination, principles of contact investigation and interviewing skills, etc… Moreover, the “community nurse must use communication skills and nursing knowledge to interview clients for history, risks, and prevalent medical conditions, provide case-finding and clinical services to eligible clients living in shelters, group homes, LTAC’s, and correctional facilities” (tbcontrollers.org, 2012).

Program planning is another domain that a community nurse should be an expert on. He / she must use knowledge of current guidelines and local epidemiology to plan program-wide interventions effectively. The following are program planning tasks for the public health nurse / case manager: implement policy and program improvement, incorporate policy into organizational structures, plans, and programs, develop strategies for continuous quality improvement. Three more domains that a qualified public health nurse must be proficient in are cultural competency, community collaboration, and leadership. “The TB nurse case manager is a qualified nurse who uses knowledge of community resources and stakeholders to foster partnerships within the community” (tbcontrollers.org, 2012).

Collaboration with partners, promotion of public health policy and programs, and providing expert advice to other healthcare providers are examples of core competencies of the said domain. Lastly, the nurse’s communication skills are a big key to managing TB in the community. Mutual goal setting, providing emotional support, and educating the patient are key tasks included in the communication domain. Some specific actions are disseminating TB educational materials in different formats, recognizing and addressing misconceptions about the disease, and using appropriate language and language level while conducting patient education. (tbcontrollers.org, 2012).

A popular nationwide agency that addresses tuberculosis is the National Institute of Allergy and Infectious Diseases. “NIAID funds and conducts biomedical research on TB. NIAID also collaborates with other U.S. government agencies and multilateral organizations worldwide to support public–private partnerships to benefit people who have TB, multidrug-resistant TB (MDR TB), and extensively drug-resistant TB (XDR TB), including people who are co-infected with HIV” (NIH, 2007). NIAID’s contribution to resolving or reducing the impact of this disease is achieved through basic research, drug development and clinical evaluation, vaccine development and clinical testing, improving prevention and treatment for people with TB and HIV/AIDS, training, communications, and partnership (NIH, 2007).


Cdc.gov. (2014). Tuberculosis (TB). Retrieved from: http://www.cdc.gov/tb/statistics/ Hargreaves, J., Boccia, D., Evans, C., Adato, M., Petticrew, M., Porter, J. (2011). The Social Determinants of Tuberculosis: From Evidence to Action. Am J Public Health. 2011 April; 101(4): 654–662. Herchline, T. (2014). Tuberculosis. Retrieved from:

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Mcmurray, JJ. (2007). An epidemiological study of pulmonary arterial hypertension. Eur Respir J. 2007 Jul;30(1):104-9. Epub 2007 Mar 14

NIH. (2007). Tuberculosis (TB). Retrieved from:

http://www.niaid.nih.gov/topics/tuberculosis/research/pages/niaidsrole.aspx Reichler, MR., Reves, R., Bur, S. Thompson, V. Evaluation of investigations conducted to detect

And prevent transmission of Tuberculosis. Journal of the American Medical Association


Smeltzer, S., Bare, B., Hinkle, J et al. (2004). Brunner and Sudarth’s Text Book of Medical Surgical Nursing. 10th edition. Philadelphia Lippincott Williams & Wilkins Publishing Tbcontrollers.org. (2012). The tuberculosis case management for nurses: Self-study modules.

Retrieved from: http://tbcontrollers.org/docs/CoreCompetencies/NCMCompetencies- draft04052012.pdf

The Merck Manual. (2014).Tuberculosis (TB). Retrieved from: http://www.merckmanuals.com/professional/infectious_diseases/mycobacteria/tuberculosis_tb.html

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