Impact of Poverty on Mother-Child HIV Transmission - Thesis Example

The Impact of Poverty on Mother-Child HIV Transmission and the Therapeutic Intervention in South Africa Introduction a) Background of the study Poverty is a global concern affecting a great proportion of the world population. Majority of people that are greatly affected by poverty come from the developing countries in Africa and South America. Poverty, especially in African countries is caused by unemployment of the unskilled laborers (Fosu, Mwabu, & Thorbecke 2009). According to (Puuka et al. 2012), about 2.8 million people in South Africa are not in employment, training, or education. As a result, these people live in poverty with inability to access basic essentials. According to Oosthuizen (2006), poverty levels in South Africa are divided into absolute, relative, and subjective. Absolute poverty in this case is the inability for one to meet basic need while relative poverty is whereby individuals and the community lag behind in welfare. According to Mail Guardian (2011), almost half of South Africa population lives below the poverty line, surviving on just over R500 a month. Though poverty levels have been decreasing over time, the country still lags behind due to the high level of unemployment. It is estimated that only 41% of adults are employed (Mail Guardian 2011). According to Cox (2008), poverty has caused a significant effect on the financial power of the affected women than men. According to Rosenweig et al. (1998), lack of adequate finance, affordable housing, and skills have exposed single parents to engage in dangerous promiscuity like prostitution hence increasing their risk of contracting HIV and Aids. In South Africa, women accounts for more than 57% of individuals living with HIV (Henry 2005). Moreover, majority of women living with HIV are within 25 to 35 years (Henry 2005). This is a childbearing age hence; there is a very high likelihood of having mother-to-child HIV transmission. In response to the effect of HIV and mother-to-child transmission, the government of South Africa has come up with various intervention strategies. Among them is public health education, advocating for Caesarean section during delivery, substituting breastfeeding after delivery, use of antiretroviral drugs for the infected mothers and tax waive on antiretroviral drugs (Haarmann 2000). However, Antiretroviral drugs (ARVs) are the most popular of all the interventions on mother-to-child HIV transmission (Chigwedere et al. 2008). It increases child survival and decreases HIV related morbidity and mortality. For a pregnant mother to be able to use ARVs, the person goes through several phases with screening for pregnancy being the first stage. Upon confirmation of a positive HIV status, HIV services introduction, which is the second stage, starts. The introduction entails patient readiness assessment and treatment initiation. Upon confirmation that the individual is fit for ARVs, the therapy starts at 36 weeks gestation with surveillance on the HIV suppression levels being done first weekly then later fortnight (DOH 2004). After delivery, the HIV positive mother is advised to visit the delivery facility for follow-up on ARVs care until 6 weeks. At this point, the child is tested for HIV status. If the child is HIV exposed, then the mother is advised to stop breastfeeding to avoid infecting the child (DOH 2004). According to (Kriegshaber & Downing 2008), the most affected populations cannot afford ARV medication. This is highly favored by the low-income levels that facilitate a continued growth of poverty levels. However, use of ARV on both mother and infected child requires knowledge about them as well as financial resources. The HIV positive mother is required to have attended HIV clinics to be educated on therapy levels (DOH 2004). This helps in reducing ARV side effects like taking large number of tablets. Poverty level makes many HIV positive mothers to be unable to access ARVs hence contributing largely to continued mother-to-child HIV transmission. b) Problem statement Despite the high poverty level, poor health leads to reduced physical strength and stamina thus reducing productivity that later affects economic strength (McLaren 2011). The situation becomes worse when HIV infected persons, who are physically weak are unable to access the provided intervention measures like ARVs, Caesarean section and substitute of breastfeeding. The problem investigated by the research proposed by this paper is the effect of poverty on mother-to-child HIV transmission. The research will also evaluate whether poverty level in South Africa has been affecting mother-to-child HIV transmission and interventions. The proposal also investigates the effects of various therapeutic interventions on mother-to-child transmission. In such a case, the government of South Africa should further evaluate its therapeutic intervention strategies. c) Research hypothesis Raise in poverty level has been increasing mother-to-child HIV transmission in South Africa. Poverty levels in South Africa have made the intervention program for mother-child HIV transmission to be ineffective. Mother-to-child HIV transmission interventions adapted by the governments have a varying effectiveness in achieving their goals. Though South Africa has several Mother-to-child HIV transmission interventions, there is need for evaluating their effectiveness as well as considering areas of improvements. d) Purpose statement The purpose of the proposed research would be to evaluate current mother-to-child HIV management policies in South Africa as well as recommend the necessary improvements on the policies. The policies to be evaluated include management policy in utero, management policy in labor, management policies in neonatal period, management in infanthood and last but not least management policy in childhood. The research will also evaluate the influence of poverty on mother-to-child HIV transmission in South Africa. This would be achieved through investigation of poverty distribution in South Africa and distribution of HIV infections in the country. Investigation of the availability of intervention program designed by the government and communities would also assist a lot in researching the identified problem. e) Limitations of the study Poverty levels in South Africa are influenced by many factors with age being one of them (Haarmann 2000). One limitation of this study is that it would not categorize women according to their age. This is because of the research complications that might arise from categorizing individuals according to their age. As a result, the research findings would not be able to reveal how poverty affects mother-to-child HIV transmission and intervention among women of different ages. Moreover, the research focuses on poverty in relation to mother-to child HIV transmission among women. This will limit the scope of the research, which could lead to a limit on the amount of information required for the topic. f) Significance of the study However, the investigation would be very significant to different people in the society. Despite having a limited scope, the findings of this investigation would form a very good basis for further research. Public health researchers could use the findings of this research when undertaking further research on mother-to-child HIV transmission and intervention. Moreover, the research investigation proposed by this study would be of great help to policy analyst. This is because it would reveal whether the current policies designed for preventing mother-to-child HIV transmission have been effective hence provide them with a guide on the introduction of new policies to make the intervention programs more effective. Another group of individuals that would greatly benefit from the proposed research is the women living with HIV. One of the benefits that this group of people would get from the investigation is knowledge of how to avoid transmitting the virus to their unborn babies. The research will expose HIV infected women to the knowledge of the enhanced policies like tax waiver. Moreover, this group of people would benefit from enhanced policies and further research undertaken on the issue identified for the proposed research. This is because information obtained in the investigation would be crucial in promoting policies and research concerning the effects of poverty on mother-to-children transmission of HIV. Research methodology a) Theoretical framework The research methodology to be used in this research would be a quantitative research method. According to Hall (2008), investigating and evaluating the cause of a problem is the main domain of quantitative survey. This is in line with the demands of the research topic proposed by this proposal. Quantitative research method brings out results in numerical form (Hall 2008). This makes it easy to interpret and explain the cause and effects of the concepts of interest. Moreover, the research topic in this case is relational. Only quantitative research method can be used since it has the ability to bring out differences and relationships among measures. In the research, we will require more reliable and valid measures and only quantitative research can offer that hence making it the most appropriate method to use in this research. Proposed research would be undertaken in form of a survey. This is because of its simplicity and ability to cover a large population of respondents within a short time. In addition, the designing of the survey would be the first stage in the research after the identification of the research methodology. The designed survey would depend on several factors with population distribution being one of them. Population distribution information would be obtained from the South African census bureau and organization of people living with AIDs. Another factor that would influence the survey design would be the resources and funds available for the research. The survey designed would act as a guiding tool in undertaking other research activities. b) Projected Cost The proposed research is projected to cost around $35,000 with materials and equipments to be used in the research taking 40% of the total. Salaries of the research team and travelling expenses are projected to take $ 7,000 and communication and rent in case of a need for accommodation would take $10,000. There will be an allocation of $ 4,000 for miscellaneous expenses. c) Selection and description of participants In undertaking the survey, selection of the sample from the identified population would be paramount. The population in this research would comprise women within the childbearing age and living with HIV infections. This population is large and widely distributed throughout South Africa. As a result, collection of data and information from the whole population would be illogical and uneconomical. For this research, a stratified random sampling technique would be used to identify the sample. This sampling technique involves subdividing of the population before randomly selecting the sample from each of the identified population subgroups. In this case, the researcher will subdivide the whole population of the identified HIV positive mothers into subgroups. The smallest subgroup will be considered for the research to achieve the desired error level and confidence. In this subgroup, a small number of people for survey will be calculated and the required research ration will be filled by getting the number of people required for the survey from all the other subgroups. Once the researcher is sure of the exact number of people to use in the survey, participants will be selected at random. Three hypothetical groups of individuals would be used to subdivide the population. The groups would be urban women living with HIV, suburban women living with HIV, and rural women living with HIV. To reduce the problem of biasness, a sample of 1200 participants would be used in the research. The 1200 participants in the samples would be selected equally from the three subdivisions of the population. Each of the subdivision would produce 300 participants that would be randomly selected from the whole subdivision. The identified individuals for the sample would have to meet several requirements. They will be required to: Be HIV positive or living with an HIV positive woman. Be women because women understand other women’s problems better than men. Be within childbearing age. d) Ethical Consideration Ethical consideration forms an integral part in the research planning stage (Hall 2008). First, the researcher will acquire research permit from National Research Foundation. The participant, who in this case are a sensitive group, need to be protected from stress by considering a mutual agreement between the researcher and the participant before the start of the survey. Another thing is that the researcher is quite aware of the level of sensitivity on exposure of one’s HIV status. This will need the researcher to assure the interviewee the highest level of confidentiality. The researcher will take the survey as a private venture between the researcher and the interviewee. This will assist in preventing future discrimination, victimization, and stigmatization to the interviewee. e) Data collection Several data collection techniques are available for survey research. Each of these techniques has its own advantages as well as disadvantages. One of the techniques that would be used to collect data in this research would be an administered questionnaire. An expert like an interviewer administers this questionnaire. The major reason why this technique is selected for this study is that it has a high response rate and is less time consuming. The questionnaire used in this research would include both open ended and guided questions. This would mainly aim to ensure that the research team acquires adequate and reliable data. The research team in this case comprise of a project leader, three research coordinators, three supervisors and a team of 20 interviewers. The project leader will lead the team in the implementation of the project. The coordinators, each taking care of one of the three subgroups, will be answerable to the project leader. They will also make sure the project runs smoothly by making sure the staff have the required equipments for the research. The project supervisors, who are answerable to the research coordinators, will supervise the interviewers. They will first train the interviewers and work with them in the field during data collection. The interviewers are responsible for participants’ recruitment. They will also assess eligibility as well as collect data required for the research. f) Data analysis To arrive at a conclusion, all the collected data will need to be processed and analyzed. The data collected will be processed using three stages. The first stage would be data editing to minimize the missing data and any form of irregularity in the data. The second stage would be data coding, which involves assigning of numbers to the data that has been collected in non-numerical form. The last stage would be data entry. This is entering the collected data in computer software for analysis. Two statistical software systems that would be used to analyze the quantitative data collected in this research would be SPSS and R-program. Each of these statistical software systems has its own advantages and disadvantages that necessitated them to be used together. Literature review Several scholars have studied on issues related with poverty and its effects on Mother-to-child HIV transmission in South Africa. Anderson (2010) found out that poverty has a very great effect on the level of crimes and deterioration of moral values in South Africa. Due to the level of poverty, women engage in dangerous promiscuity that in the end fuels the epidemic. This vice is also in the pregnant women who end up transmitting HIV to their off springs. This scholar also show that effects of poverty are always more conspicuous among the young adults with women facing them more severely than men. Haarmann (2000) studied on the relationship between social assistance and poverty alleviation in South Africa. She found out that social assistance assists a lot in the reduction of poverty levels in the republic of South Africa. However, these two scholars did not reveal how poverty influences public health in South Africa. Other scholars have studied the issues of South African public health and various factors that hinder its improvements. Kalua et al. (2009) reveals that African countries including South Africa have been facing formidable challenges in their public health due to the wide spread of HIV/AIDs. However, they do not relate HIV transmission and intervention with poverty levels in this country in their research. Youde (2007) explains various ways that the republic of South African has been using to respond to its public health issues. The research explains how these response actions have evolved through years. Moreover, it evaluates various government responses to HIV/AIDs like providing ARVs and advocating for caesarean section instead of normal delivery. However, the work of this scholar does not relate public health with poverty levels in South Africa. Moreover, other scholars have studied the issue of mother-to-child transmission of HIV virus. Van Dyk (2008) identified that mother-to-child or vertical transmission is the major cause of HIV infection in children. His findings explain this issue in the context of the world. This makes it to be very general thus leaving out some of the issues related to mother-to-child transmission of HIV associated with South Africa. Kabongo (2011) studied the relationship between mother-to-child transmission of HIV and mortality and morbidity rate in the world. He found out that reduction of mother-to-child transmission of HIV could greatly reduce the level of HIV in children thus reduce the mortality and morbidity rate in children. Moreover, the research undertaken by this scholar was not done in the context of South Africa. Several scholars have addressed the issues of intervention programs for mother-to-child transmission of HIV. Lawrence & Lawrence (2010) reveal that breastfeeding has been one of the major ways in which HIV is transmitted from a mother to a child. As a result, the work of this scholar proposes that mothers with HIV should avoid breastfeeding their babies and start giving them supplements like formula. However, some supplements are unaffordable while others might have a negative impact on the child. Dicks (2002) studied the impact of mother-to-child HIV interventions in the developed countries. The findings of their research indicated a significant reduction of HIV infection levels among children after intervention programs were employed. However, there are still some lapses since there are still a 20% of HIV infected mothers who were exclusively breastfeeding in South Africa (MRC 2012). This could be because of lack of finances to purchase alternative feeding methods for infants. MRC (2012) in its efforts to evaluate the effectiveness of national intervention of PMTCT revealed that the rate of PMTCT services have been on the rise with a significant number of 98% of pregnancy women being tested for HIV and among them 91.7% infected mothers receiving ARVs. Gullotta & Bloom (2003) also did a study on the therapeutic interventions undertaken so far. They identified alternatives to breastfeeding, caesarian section and ARVs as the most effective interventions taken. In their study, they highlighted that caesarean section and ARVs protect the child before birth while supplemented breastfeeding avoids transmission after birth. Moreover, these scholars highlighted that some strategies like C-section have maternal morbidity and mortality. They also highlighted that some countries like South Africa are short of resources to fund the procedure in every HIV infected pregnant mother. This is a major setback brought about by poverty level. Timeline feasibility The proposed research is expected to take 5 years and would be undertaken in three phases. The first phase, which would take the first one year, would consist of literature review and survey designing. This phase would be the shortest because it would not contain time-consuming activities. The second phase, which happens to be the longest, will take three years of the total allocated time. This phase would contain research activities like sample identification, designing of data collection tools, and actual data collections. Most of these activities are time consuming that is why the phase has been allocated much of the time available for the research. The final phase would take one year. This phase would consist of activities like data processing, data analysis, and report writing. The phase would finalize everything done in the research to provide research findings and conclusions in the most understandable manner. References Anderson, MD, 2010, The Effect of Poverty on Crime in South Africa: A GMM and IV Approach, Retrieved from: http://stage-cpe.ucsd.edu/assets/002/6932.pdf, On 1 October 2012. Chigwedere, P, et al., 2008, Efficacy of Antiretroviral Drugs in Reducing Mother-to-Child Transmission of HIV in Africa: A Meta-Analysis of Published Clinical Trials, Retrieved from: http://www.igh.org/cochrane/chigwedere_etal.pdf, On 1 October 2012. Cox, FD, 2008, Human Intimacy: Marriage, the Family, and Its Meaning, Belmont: Wadsworth Cengage Learning Ltd. Dicks, BA, 2002, HIV/AIDS and Children in the English Speaking Caribbean, New York: The Haworth Press. DOH 2004, ‘National Antiretroviral Treatment Guideline’, National Department of Health South Africa 2004, Retrieved from: http://www.kznhealth.gov.za/arv/arv5.pdf, on 6 October 2012. Fosu, AK, Mwabu, GM, & Thorbecke, E, 2009, Poverty in Africa: Analytical and Policy Perspectives, Nairobi: University of Nairobi Press. Gullotta TP & Bloom M, 2003, Encyclopedia of Primary Prevention and Health promotion, New York: Kluwer Academic/Plenum Publishers. Haarmann, C, 2000, Social Assistance in South Africa: Its Potential Impact on Poverty, Retrieved from http://www.cdhaarmann.com/Publications/C_PhD_w.pdf, On 1 October 2012. Hall, R, 2008, Applied Social Research: Planning, Designing, and Conducting Real-World Research, Sydney: Palgrave Macmillan Ltd. Henry, J, 2005, HIV/AIDS Policy Fact Sheet: The HIV Epidemic in South Africa, Retrieved from: http://www.kff.org/hivaids/upload/7365.pdf, On 1 October 2012. Kabango, L, 2011, Protection of Mother to Child Transmission of HIV: Towards “Virtual Elimination of Pediatric HIV” in Rural Western Zambia, Norderstedt: GRIN Verlag Ltd. Kalua, F, et al, 2009, Science, Technology, and Innovation for Public Health in Africa, Retrieved from: http://www.nepadst.org/doclibrary/pdfs/stipha_mar2009.pdf, On 1 October 2012. Kriegshaber, J & Downing, M, 2008, Pharmaceutical Pricing for ARV Drugs in South Africa, Retrieved from http://kelley.iu.edu/CBLS/files/DowningKriegshaberG400PharmaReport2.pdf, on 6 October 2012. Lawrence, RA, & Lawrence, MA, 2010, Breastfeeding: a Guide for the Medical Professional, 7th edn, Maryland Heights: Elsevier Ltd. Mail Gurdian, 2011, Poverty and Inequality in South Africa, Retrieved from http://mg.co.za/article/2011-09-16-poverty-and-inequality-in-south-africa, on 9 October 2012. Mclaren ZM, Employment Outcomes in South Africa, Retrieved from: http://www.econ.yale.edu/conference/neudc11/papers/paper_097.pdf, on 6 October 2012. MRC 2012, Evaluation of the Effectiveness of the National Prevention of Mother-to-child Transmission (PMTCT) Programme Measured at Six Weeks Postpartum in South Africa 2010, Retrieved from: http://www.doh.gov.za/docs/reports/2012/pmtcteffectiveness.pdf, on 6 October 2012. Oosthuizen, M 2006, estimating Poverty Lines for South Africa, Retrieved from: http://www.info.gov.za/view/DownloadFileAction?id=85513 on 9 October 2012. Puuka, J, et al., 2012, Higher Educational in Regional and City Development: The Free State, South Africa 2012, Retrieved from: http://www.oecd.org/edu/imhe/50008631.pdf, On 1 October 2012. Rosenweig, M, et al., 1998, From the Source: A Guide for Implementing Prenatal Addiction Prevention and treatment Programs, Washington: DIANE Publishing Ltd. Van Dyk, AC, 2008, HIV/AIDS Care & Counseling: A Multidisciplinary Approach, Cape Town: Pearson Education South Africa Ltd. Youde, JR, 2007, AIDS, South Africa, and the Politics of Knowledge, Hampshire: Ashgate Publishing Ltd. Read More