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PHCA9509 Public Health Practice Development

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PHCA9509 Public Health Practice Development Question: It is third and last assignment in continuation of my previous assignment I am sending my second assignment as well to continue the third assignment it is requested to use the references of second assignment . My topic is ” to explore the determinates of HIV amongst the truck drivers in INDIA” please follow the marking criteria I am sending along with my previous assignment. Please wright all the literature .in NARRATIVE VIEW. I am sending rough idea about structure of assignment also one example of literature review in Narrative review it may help. Review the evidence and apply the findings to your culture/setting: Reflect on the findings from the literature review and consider the implications for your chosen issue. What to expect from the paper. Introduction A summary of what was presented in Assignment 1 and 2 + AIM Methods How search was conducted (once again, (how much of this can be carried over from Assignment 1 and 2 Results List themes emerging from thematic analysis Themes Discussing the wider SDoH under each of the themes. Discussion Discussion implications for PH practice in setting. Conclusion Summary of report and recommendations for the future? Answer: Introduction In India HIV/AIDS is the number one public health problem in the country since independence. This is due to the large part of the population that is affected either directly or indirectly by the disease. Globally, HIV is one of the most serious burdens of disease that contributed to 36.7 million HIV patients worldwide during the year 2015. According to the report by UNAIDS (2013)”India stands as the country with the third higest number of people living with HIV in the world.” In countries like India, people with HIV or HIV risk do not have proper access to healthcare services encompassing prevention, treatment, and care. Also, there is a high risk of HIV among the Indian population. Although there sexual behavior of truck drivers which expose them to the highest level of risk, there is not much research on the social determinants of HIV among the Indian truck drivers. They do not have much clue about the possible causes of the way HIV got spread into the truck drivers in India. According to World Health Organization (WHO), the HIV transmission pattern is shifting from the metropolitan cities to rural Indian population (Pandey et al. 2012). According to Center for Disease Control and Prevention (CDC), India is a high priority site for the prevention and explosion of the infections among the truck drivers (Ghate et al. 2011). The transmission and prevalence of HIV vary according to the geographic location of India, and the long-distance truck drivers are involved in unprotected sexual activities that increase the risk for HIV transmission among them. This high risk of sexual behavior among these truck drivers also put the general population at risk. There has been limited research that helps to understand the dynamics of this viral infection transmission in the Indian truck drivers. Moreover, it is also significant to have a reflection on the determinants of the Human-Immune-Virus among them that would be helpful in preventing and in reducing the HIV transmission among the truck drivers in India. This issue is important to study as it is a vital segment that experience decimation of reproductive health and lives of the truck driver population in India. Aim Of The Research Even though there have been high levels of risky sexual behavior for HIV transmission in India, not enough studies have been done on it as well as other factors such as condom use and the potential for positive behavioral change among Indian truck drivers (Saggurti et al., 2012). The aim of the research is to study the determinants of health and conduct a literature review that deals with the understanding of the determinants of HIV among the Indian truck drivers that would help to reduce and prevent the HIV transmission among the Indian truck driver population and into the general population.  Methods Three main research methodologies were employed in this research –  interviews, questionnaires and the use of websites. Interviews were used mainly to obtain information from the Indian truck drivers. They were asked about their lifestyle along the highways, if they were engaging in unprotected sex with the commercial health workers or if they knew who were doing so. They were also asked about the challenge of being away from their spouses and how they were dealing with it.  300 Indian truck drivers were interviewed on this matter. In addition, a few of their family members were also interviewed on their HIV status and care. (Saggurti et al. 2012). Questionnaire is a method of data collection where a set of questions are designed to asess the opinion of an individual on a given topic. The questionnaires that were given to various patients in this study were easy to read and understand. Even though questionnaires can be used in research on a wide number of samples, interviews are better as they can generate detailed answers and opinions of the interviewees. Websites are useful in accessing a wide range of reliable information without the need to travel. Thie information obtained from websites can be a useful aid in research and data collection. (Ghate et al. 2011). The databases used for the literature review are PubMed Central, Cochrane Library of systematic review, Google Scholar, CINAH, ProQuest, Scopus. These databases were used as they provide the appropriate information with entire coverage of literature for the students, professionals, researchers, and educators. They provided a wide range of information that was of great help in our research. The key words or search items included; Determinants Factors Sexually transmitted disease India HIV Human immunodeficiency virus Long distance truck drivers Belief Life style STD Truck drivers Risk behaviors Social determinants AIDS Lorry drivers   Educational status       Reasons       Awareness       Attitudes       The timeframe of the search was 2011 onwards as there was limited information available from 2013 onwards. The articles and data were analyzed based on the themes that the research papers contain mainly focusing on the risk behavior and determinants of the HIV infection among the Indian truck drivers. The papers of the year 2010 and below were excluded along with the papers that deviate from the main theme of HIV determinants among the Indian truck drivers. Inclusion And Exclusion Criteria INCLUSION- Article between 2011 to 2017 was considered Only published in the English language An article focusing on long distance drivers in India so as not to deviate from the topic of research. Grey literature EXCLUDED- Article published in language other than English An article focusing on population other than truck drivers like migrants. Article before 2011 Abstract which does not have many key words The research methods provided us with sufficient information regarding determinants of Human Immunodeficiency Virus among Indian truck drivers along with impacts of this on public health and measures that can be taken reduce the spread of HIV among this population (Saggurti et al. 2012). Results Over all 200 journals, government papers, books, student papers were considered. Analyzing the material abstract 132 articles were excluded, does not contain the required focus on determinants in the desired population. Later above literature reviews shows that there were certain themes that helped in the analysis of the data focusing on 14 research articles focusing on the HIV determinants among the truck drivers in India. There are themes that explain the HIV determinants among the truck drivers are the risk behaviors, time away from home, income, urban and rural residence, condoms use, and place of HIV exposure were found to be the strongest themes that correlate and associated with the spread and transmission of HIV among the trucking population in India. The consistent predictors of the research were the risk behaviors and use of condom along with the lack of knowledge and awareness for HIV among the Indian truck drivers. Themes HIV in Indian truck drivers The determinants of HIV are remarkably seen among the Indian truck drivers where the long-distance drivers get involved in risky sexual activities with the sex workers or the migrant workers. It spread to the general populations through sexual contact or because of the steady sexual partners from these primary populations. This kind of transmission to the general population is a matter of zero-prevalence in India (Pandey et al. 2011). In a survey conducted in Pune, India, it was witnessed that the married monogamous women who attended the clinic showed 13.6% of HIV positive (Pandey et al. 2012). The risk of this HIV infection has seen to spread to the occupation like the truck drivers or cleaners due to the sexual contact with the commercial sex workers. It has significantly spread and as many truck drivers’ sexual contact occurs with the commercial sex workers, the HIV risk factors are intertwined in an intricate manner. The wives of these truck drivers are tested HIV positive indicating that they have acquired the virus from their husbands and from these high-risk groups, HIV is incidence is now increasing among the general population (Saggurti et al., 2012). Risky behavior among the Indian truck drivers The Indian truck drivers show risky sexual behaviors with the commercial sex workers and similarities with the truck drivers of the other countries like Thailand and some parts of Africa. The Thailand and African drivers are less likely to use condoms, and the best predictor is the type of relationship that determines the condom use. These truck drivers use condoms with the commercial sex workers and very less with their partners or wives that are perceived to be steady. However, truck drivers in India had frequent sexual contact with the commercial sex workers along the highway rather than with their partners with less condom use. This shows that they perform unprotected sex with the commercial sex workers with a low rate of condom use that indicates a high prevalence and transmission of HIV among the truck drivers In India. According to a study conducted by Mishra et al. (2012) among the 302 truck drivers in India, 82% of them admitted the commercial sex workers along the highway, and only 28% of them frequently use condoms. Another study conducted by Schneider et al. (2012) showed that among the 6000 Indian truck drivers, 87% of them had sex with commercial sex workers and out of them, only 11% used condoms. HIV and alcohol and drug use among the Indian truck drivers appeared to be significantly correlated. Drug and alcohol abuse increased the chances of a trucker contracting HIV. This can be contributed to irresponsible behavior that people engage in when are under the influence of drugs and alcohol. Drunk drivers would most often forget to put on condoms before having sex with the commercial health workers along the highways of India (Mishra et al., 2012). In an interview conducted by Sgaier et al. (2013) among the South-eastern Indian truck drivers showed that they have scant information regarding the HIV infection transmission or prevention. 300 Indian truck drivers who stayed for a half-day to three days were interviewed who performed the activities of import and export things almost every part of India. The results also showed that the Indian truck drivers are one of the major vectors in the HIV transmission and shift to the general population. A similar study conducted by Sastry (2016) illustrated that the is the lack of motivation in the truck drivers too have sex with partners as they displayed negative attitudes towards using condoms, although they perform sex with the commercial sex workers more than their partners. The results did not favor the use of condoms among the Indian truck drivers with their wives (Saggurti et al. 2012).  Determinants of HIV The determinants of HIV are mostly determined by the behavior that results in the transmission of HIV related to sexual behavior. The sexual behavior among the truck driver populations has been associated with the HIV transmission in India. In a cross-sectional study conducted by Singh and Joshi (2012) among the lorry drivers driving on the national highway in Bhopal, India showed that 49% of them had commercial sex workers exposure and prevalence of HIV were found in 21.51 %. They did not use condoms while exposed with commercial sex workers and found careless. The incidence of HIV is seen at the sites of loading and unloading of the trucks where they stop for documentation inspection spending a considerable amount of time (Ghate et al. 2011). From a psychological aspect, the truck drivers are far away from their families due to their itinerant nature of the occupation that tends them to get exposed to commercial sex workers. Moreover, the India’s trucking population is very disorganized and unstructured that have a loose structure comprising of users, intermediates, and truck operators. Also, India has a large road networks and long distance -drivers population with the strength of 5-6 million classified into long-distance drivers. It has also been found that those who drive trucks in India have a substantial amount of exposure to female sex workers (FSWs) in the major highway routes in India (Tan et al. 2012). Another determinant is the lack of awareness and knowledge about the HIV infection and transmission. A study conducted by (Weine and Kashuba (2012) showed that out of 302 truck drivers were found to be affected by HIV infection. They are the bridging population who transmit HIV in rural India. Apart from risk sexual behavior, many of the Indian truck drivers are potential blood donors, and that also acts as a carrier of HIV infection and spread it to the general population. They are unaware of the HIV and the modes of transmission and spread. They do not have high levels of knowledge regarding HIV and are found careless in adopting the preventative measures. The truck drivers with greater income and long duration of stay away from home are at a higher risk of exposure to commercial sex workers and having multiple partners. Also, married truck drivers depicted risk sexual behavior with less use of condoms as compared to the unmarried truck drivers (Saggurti et al. 2012). The determinant of HIV spread is also witnessed at the roadside stops like the dhabas (road side hotels) where the truck drivers stop and have high exposure to commercial sex workers. They stay there for eating and lodging and highly get exposed to commercial sex workers. The mean age of the truck drivers was found to be between 18-40 years. Moreover, the health seeking behavior is not appropriate among the truck drivers as they tend to seek the healthcare facilities after the progression of the disease or else prefer to get treatment from the unqualified practitioners or home remedies as they are more accessible. In a study conducted by Mitra and Sarkar (2011) showed that there is a high level of lack of HIV risk perception among the truck drivers and significantly low or their partners of wives. This makes the truck driver population one of the major vectors in the HIV transmission in India. The availability of condoms is also less among the high-risk population of the truck drivers, and the dhabas are the main centers for the exposure to commercial sex workers causing HIV transmission. Moreover, there is less access to the healthcare services that also acts as a potential cause for the spread of HIV among them (Saggurti et al. 2012). Demographic Variables That Influence HIV Risk Behavior In a series of studies, it was consistently found that the more educated, younger, no-Hindu of the middle to upper caste Indian truck drivers are found to be apter in using condoms. Moreover, the married truck drivers are found to be having protected sex rather than those who were not married among the Indian truck drivers. Caste distinction also showed regrettable results where 52% of them were of the middle caste; more than 40% of the truck drivers were of the lower caste, and 7% of them were only of high caste. This shows that caste also acts as a barrier to the transmission as well as prevention of HIV infection (Thomas et al. 2012).  Discussion The above results show that there is a lot that should be done in the public health setting to prevent these high rates of HIV spread among Indian truck drivers. Since truck drivers cover long distances, they contribute to the faster spread of HIV/AIDS to a far much larger population and a wide area. Public health strategies for curbing this menace should, therefore, be designed in such a way as to target a big population with long-term benefits and results (Weine and Kashuba 2012). Educating the Indian truck drivers about HIV and possible ways of prevention and protection from contacting the disease form the basis of these measures. Providing education on the disease and how dangerous it will make these truck be aware of the disease and take personal preventive measures. Education is still very important and relevant those are already positive as they will learn ways of how to protect themselves and their spouses. Different ways in which HIV/AIDS awareness among Indian truck drivers can be increased include through giving information on the major media houses that cover their areas of work. Radios and television have an advantage of covering a large area and fast transmission of accurate and in-depth information about HIV, its causes, prevalence, and preventive measures and how to live with the disease (Saggurti et al., 2012). Truck drivers can also be encouraged to form working groups especially those plying the same highways or routes. In these groups, their leaders are trained on HIV, and they are expected convey the knowledge earned during the training to their members. This is the best way to spread HIV awareness among Indian truck drivers as in this there is a direct engagement in the education, and they can make a decision on the measures they will take in future to prevent the spread of the disease among them and to the general population. They may decide to stop having unprotected sex with the commercial sex workers or just to remain faithful to the wives when away on the duties (Saggurti et al., 2012). Public health set up should be made in a way where there are free and sufficient condoms available to the Indian truck drivers. Condom use provides a 99% protection from not only HIV but to other sexually transmitted diseases too. Encouraging condom use by public health officers and ensuring availability at all times will significantly reduce HIV spread and incidences among both the Indian truck drivers and to the general public. Education on the right ways of using condoms should also be emphasized as any errors in condom use could lead to HIV contraction. Use of condoms should still be encouraged when they are having sex with their wives to prevent the possible spread of the disease to their family. (Weine and Kashuba (2012) Another way in which the public health sector can help reduce the spread of HIV is by discouraging the presence of commercial sex workers along the highways. This can be done by providing the commercial sex workers with an alternative means of getting income such as creating jobs in the industries and farms. This will significantly reduce the number of commercial sex workers and therefore the spread, morbidity, and mortality resulting from HIV/AIDS infection. The public health sector also has a role to play in ensuring that health materials and equipment such as drugs, dressing, etc. are made available to the Indian truck drivers. HIV testing machines should be provided that give clear and accurate results. HIV testing is important in enabling the truck drivers to know their status that will dictate their future behaviors. The test kits should also be made available to the commercial sex workers so that they can readily test their status and that of their clients before engaging in any sexual activities. Positive behavior should be encouraged among those who may test positive (Ghate et al. 2011). One of the findings was that HIV spread among Indian truck drivers was facilitated by taking too much time away from home and their spouses, therefore, they get tempted into engaging in sexual activities with the commercial sex workers. This can be solved by allowing the truck drivers to come back home more frequently by giving them short distant trips. The spouses should also keep in touch all the time to create faithfulness and trust. Some of them should even be allowed to travel with their wives when going on a long distance journey (Saggurti et al., 2012). Conclusion The circumstances of the work of long truck drivers in India forces them to be away from their families and spouses for quite a long time. Sexual exposure to commercial health workers is therefore inevitable considering this is a sexually active group. This is a factor that predisposes them to HIV infection and makes them epidemiologically at risk to HIV infection transmission. A change in sexual behavior is therefore important in protecting these truck drivers from infection and the general spread of HIV infection to the general population. Though various public health campaigns have been made to improve HIV/AIDS awareness among this group, there still exist lacunae in their sexual behavior as highlighted by this study. To overcome this lacuna, strong actions and major efforts are required in the following areas; Provide sufficient information about all modes of HIV/AIDS transmission and other sexually transmitted diseases. Some of the methods include through sexual intercourse that can be both heterosexual and homosexual, sharing of sharp materials e.g. needles especially for truck drivers of are drug addicts and share syringes to administer a drug substance intravenously (Ghate et al. 2011). Condom use should also be promoted among the truck drivers. This can be done by involving other stake holders to acquire sufficient condoms to be distributed to all of them as well as commercial sex workers on major highways. Truck drivers’ union leaders, transport company owners, and non-governmental organizations can be help in distributing and delivering these condoms (Saggurti et al., 2012). References Ghate, M., Deshpande, S., Tripathy, S., Godbole, S., Nene, M., Thakar, M., Risbud, A., Bollinger, R. and Mehendale, S., 2011. Mortality in HIV infected individuals in Pune, India. Indian Journal of Medical Research, 133(4), p.414. Mishra, R.M., Dube, M., Saggurti, N., Pandey, A., Mahapatra, B. and Ramesh, S., 2012. The association between adolescent entry into the trucking industry and risk of HIV among long-distance truck drivers in India. HIV/AIDS (Auckland, NZ), 4, p.141. Mitra, A. and Sarkar, D., 2011. Gender inequality and the spread of HIV-AIDS in India. International Journal of Social Economics, 38(6), pp.557-572. Pandey, A., Mishra, R.M., Sahu, D., Benara, S.K., Biswas, M., Sengupta, U., Mainkar, M.K. and Adhikary, R., 2012. Heterosexual risk behaviour among long distance truck drivers in India: Role of marital status. Indian Journal of Medical Research, 136(7), p.44. Pandey, A., Mishra, R.M., Sahu, D., Benara, S.K., Sengupta, U., Paranjape, R.S., Gautam, A., Lenka, S.R. and Adhikary, R., 2011. Heading towards the Safer Highways: an assessment of the Avahan prevention programme among long distance truck drivers in India. BMC Public Health, 11(6), p.S15. Pandey, A., Sahu, D., Bakkali, T., Reddy, D.C.S., Venkatesh, S., Kant, S., Bhattacharya, M., Raj, Y., Haldar, P., Bhardwaj, D. and Chandra, N., 2012. Estimate of HIV prevalence and number of people living with HIV in India 2008–2009. BMJ open, 2(5), p.e000926. Saggurti, N., Nair, S., Malviya, A., Decker, M.R., Silverman, J.G. and Raj, A., 2012. Male migration/mobility and HIV among married couples: cross-sectional analysis of nationally representative data from India. AIDS and Behavior, 16(6), pp.1649-1658. Sastry, S., 2016. Long distance truck drivers and the structural context of health: a culture-centered investigation of Indian truckers’ health narratives. Health communication, 31(2), pp.230-241. Schneider, J., Kumar, R., Dandona, R., Kumar, P., Kumar, A., Lakshmi, V., Laumann, E., Mayer, K. and Dandona, L., 2012. Social network and risk-taking behavior most associated with rapid HIV testing, circumcision, and preexposure prophylaxis acceptability among high-risk Indian men. AIDS patient care and STDs, 26(10), pp.631-640. Sgaier, S.K., Ramakrishnan, A., Dhingra, N., Wadhwani, A., Alexander, A., Bennett, S., Bhalla, A., Kumta, S., Jayaram, M., Gupta, P. and Piot, P.K., 2013. How the Avahan HIV prevention program transitioned from the Gates Foundation to the government of India. Health Affairs, 32(7), pp.1265-1273. Singh, R.K. and Joshi, H.S., 2012. Sexual behavior among truck drivers. Indian Journal of Public Health, 56(1), p.53. Tan, J.Y., Huedo-Medina, T.B., Warren, M.R., Carey, M.P. and Johnson, B.T., 2012. A meta-analysis of the efficacy of HIV/AIDS prevention interventions in Asia, 1995–2009. Social Science & Medicine, 75(4), pp.676-687. Thomas, B., Mimiaga, M.J., Mayer, K.H., Perry, N.S., Swaminathan, S. and Safren, S.A., 2012. The influence of stigma on HIV risk behavior among men who have sex with men in Chennai, India. AIDS care, 24(11), pp.1401-1406. Weine, S.M. and Kashuba, A.B., 2012. Labor migration and HIV risk: a systematic review of the literature. AIDS and Behavior, 16(6), pp.1605-1621.

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