A STUDY TO DETERMINE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON PREVENTION OF HIV AMONG THE NURSES AT SELECTED PRIMARY HEALTH CENTERS IN BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

FOR

DISSERTATION

Mis.K.SHEEBA RANI

BANGALORE CITY COLLEGE OF NURSING

BANGALORE

September-2010

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Name of the Candidate & Address /
K.SHEEBA RANI
No. 160, Chilikere, Kalyan nagar Post Bangalore – 43.
Name of the Institution / Bangalore City College of Nursing
Course of Study and Subject
Child Health Nursing / 1st year M.sc (Nursing)
Community Health Nursing
Date of Admission / 05-10-2010
Title of the Topic / “A Study to Determine the effectiveness of self instructional module on prevention of HIV among the Nurses at selected primary health centers in Bangalore.”

6. BRIEF RESUME OF THE INTENDED WORK:-

INTRODUCTION:-

“The Nurse a lieutenant or first officer, who is the real commander when the captain is unfit for his place A nurse who has the care of the people especially .one who has the care of the sick or infirm eyes for the deaf light for the dark and pioneer for door the disabled”.

The beauty of nature which includes small herbs, plants and trees with fresh fruits, and flowers with fragrance, animals, which are wild, domesticated, and we are the human beings, the first and foremost created by the God. It is really amazing and great that we are kept high and given power to rule the earth. “Prevention is better than cure” so every person when they attain maturity. When we attain maturity through an orderly process of growth and development like biologic social and cognitive and moral systems people may play a major rule to build up the country. It’s very important for the people to know their healthy life style, healthy Behavior, and risk behaviors, and too aware of HIV disease transmission and prevention and follow up.

HIV is the retro virus human immunodeficiency virus usually contain an enzyme Reverse transcriptase that helps in converting RNA to DNA during the replication processes unlike most viruses, HIV cannot be destroyed by the body. After becoming infected, a person has HIV infection for the rest of HIS/HER life HIV cannot stay alive outside the human body unless under laboratory conditions. The human immune deficiency virus is a retrovirus that infects cells of the immune system destroying or impairing cells of the immune system becomes weaker and the person becomes more susceptibility to infection the most advanced stage of HIV infection is AIDS. its take 10-15 yrs for HIV infected person to develop AIDS, The epidemiological studies throughout the world have shown 4 modes of transmission unsafe sexual contact, transfusion of contaminated blood, use of contaminated syringes, and from infected mothers to child are routes of transmission of HIV.

The immune system fight infection in side the body prefect the body by recognized & destroying: infection agent such as bacteria viruses and parasites T-lymphocytes are processed and stored in the Thymus the most important of T-lymphocytes are CD4 type and CD8 type. B-lymphocytes are produced in the bone marrow the HIV especially attracted to the CD4 type of lymphocytes it enters the CD4 lymphocytes and multiplies in them there by destroying the CD4 cells gradual loss of these CD4 cells result in the loss of immunity in theses patient if leads to person go to AIDS.

The global scenario 2009 33.3 million people living with HIV world wide in 2009 2.6 million People become infected with the virus in 2009.8 million People died of HIV related cases in 2009.The annual number of AIDS death has declined in the past five years form 2.1 million (1.9 million -2.3 million in 2004) (1.6 million -2.4 million) in 2009 Evolution of HIV in India First HIV case in India was reported from Chennai in 1986.First case of AIDS was reported from Mumbai in 1987.

HIV cases are now in all states of India approximately 2.27 million PLHIV in India (NACO-2008-2009). All districts across the country are classified in to prevalence in A, B, C, &, D based on prevalence in antenna has women & high risk groups HIV infection spreading rapidly in India. It is recognized as a public health problem particularly due to their high risk behavior that is multiple sexual partners’ men who having sex with men and core group of injecting drug users. The total number of people living with HIV/AIDS (PLHA) in INDIA is estimated at 24 lakhs, in 2009. Children (<15yrs) account for 3.5% of all infections. While 83% are the age group (15-49 yrs) of all HIV infections 9.3 lakhs, 39% are among women. The 4 prevalence states of south India (Andrapradesh 5 lakhs, Maharashtra 4.2 lakh, Karnataka 2.5 lakh, Thailand 1.5 lakh,) account of 55% of all HIV infections in the country. Using globally accepted methodologies and updated evidence on survival to HIV with and without treatment it is estimated about 1.72 lakh people died of HIV/AIDS related causes in India.

The WHO World health organization ,the joint united national programme on HIV/AIDS (UNAIDS) and the united states centers for disease control and prevention (CDC),recommend provider initiated testing and counseling (PITC) as a cost of effective and ethical way of improving access to HIV testing during general epidemics. An early diagnosis of positive HIV status helps prevent and significantly delay morbid conditions, associated with regular routine positive thinking and family support helps in better management of the infection. In this health care system and community based organizations / faith based organizations work together in providing medical care counseling economic and legal support to living with HIV/AIDS and their families.

Mr.K.chandramouli secretary to government of India ministry of family and welfare and director general, national aids control organization (NACO) said “As part of the government of India’s keen focus on generating strategic information towards stronger evidence based programming and result oriented action. The NACO has reinforced its commitment to quality data generation and utilization by scaling up the surveillance system over the previous and drawing on technical expertise of national and international organizations.

According to Mr.K.chandramouli given the diversity of the epidemic and the increasing prevalence amongst specific populations and geographical locations we need to renew our commitment to adopt and strengthen HIV prevention strategies we need also to protect people most affected and promote human and gender rights. For this India work towards comprehensive response to HIV/AIDS that unifies forces of stake holders and integrates HIV prevention, treatment, care and support.

A large number of HIV infections and AIDS cases resulted from various transmission routes ; drug injecting hetero sexual and homosexual and Thailand was detected in a Thai homosexual student returning from the United states to Bangkok in 1984.The first case of AIDS was identified in 1984. Rapidly to the developing HIV epidemics were identified primarily among people who injecting Drugs (PWID) HIV prevalence rose from 0% to 4.9%with in one year (1987-1988) HIV prevalence among military conscripts and pregnant women reached a peak at 3.40% and 2.29%in (1992-1995). In 2005 it is estimated that over a million people have been infected with HIV since the epidemic started ;5,85,800 people have died of AIDS ,people live with HIV 5,32,500 and 12,800 new HIV infections would have occurred in 2008. In India more than 1, 88,000 people living with HIV/AIDS are accessing ART (Antiretroviral therapy) from public sector hospitals/clinics as of November 2008. NACO proposes to deliver ARV therapy through effectively functioning health infrastructure and properly trained and motivated staff.

“Opportunities are the gift of god” use them in a correct way” by this the people has to controlled protected out from the future dangerous and out comes of living with HIV”.

6.1 NEED FOR STUDY:-

“Knowledge with love firmness with gentleness practices with understanding attention to deal with wisdom ethical values with moral attitude and standards of excellences.”

“To understand something you need knowledge but to fell it you need experience.”

According to UNAIDS Globally there were estimated 403 million people infected with HIV in 2007, with 2.7 million new infections, and 2 million HIV related deaths, nearly an estimated 5 million people infected with HIV lived in ASIA in 2007, and about 3,80,000 people were newly infected. According to NACO in India the estimated number of HIV infections as of 2008 is 2.47 million. The distribution of HIV infection and mode of transmission varies by state. Most HIV infections in India (86% of the reported AIDS cases) are due to unprotected hetero sexual transmission (UNAIDS 2008) report on Global AIDS epidemic.

The nurses are the first and focal, vital point of contact of the HIV infected in a hospital setting or any setting with in patient facility. The nurses need to be equipped with adequate knowledge on HIV/AIDS and all the aspect including prevention of treatment, care & support this will not only enable them to protect them selves from getting infected with HIV but also help in reducing stigma and discrimination against people infected with HIV and encourage nurses to provide quality care and support services to the PLAH ’s (people living with HIV /AIDS) in a recourses limited setting where there is a dearth of qualified Professionals to conduct quality counseling it have become increasingly important to train the nurses in the art of quality counseling for long term sustainability.

The nurses is in the ideal situation for this role as she/he is often the “primary contact’ for the patient family and other members of the health care them presently in most settings the social workers takes on this crucial role but the could take on this crucial role become the nurses is the one who is in the hospital in contact with the patient for the longest period often the “coordinator” of the care plan for the patient from start to finish frequency the tem members who makes it all happens The nurses the main role in prevention of HIV transmission it includes primary and secondary prevention strategies as like preventing transmission infection to safe using of other blood offering pre and post test counseling to the people at risk ANC women patient attending STI clinics or received treatment for Tuberculosis harm reduction Strategies for IDU safe sex practices including condom use and facilitate positive living. So she has the different and more responsibility the HIV.

Bridge population comprises people who through close proximity to high risk groups are of the risk of contracting HIV. Quite often they are clients or partners of male and female sex workers. Truckers and migrant labors are major bridge populations. Bridge populations are critical group because of their mobility with HIV. Their living and working conditions, sexually active age and separation from regular partners for extended periods of time predispose them to paid sex or sex with non regular partners. Further inadequate access to treatment for STI’s aggravates the risk of contracting and transmitting the virus. Assistance and condom use are usually not the option-s available to- women-since social norms are that women are not supposed to be sexually knowledgeable. This is compounded in respect of sex workers who are doubly stigmatized and marginalized. Prevalent notions of masculinity and felinities generally mean that women have little control or negotiating power in their sexual relationships including marriage. Strategies counseling service among the people in this world.

In India people in the age group 15-39 years comprise almost 25% of the country’s population on physiologically young are more vulnerable to sexually transmitted diseases than adults, girls more than boys, gender imbalances, societal norms, and economic dependence, contribute to risk lack of access to correct information, tendency experiment, and an environment, which makes discussing issues around sexuality taboo adds to their vulnerability. At this stage they are more likely to have multipart unprotected sex with high risk behavior groups particularly vulnerable are impoverished, unemployed, underemployed, mobile /migrant youth, adolescents in sex work, young injecting drug users, and street children, as they are faced with high behavior in their everyday life. And they face repeated reinventions. Woman are biologically more gap to HIV infection than young men a situation aggravated by their lack of access to information to HIV &even lesser power to excessive control over the is sexual lives early marriages also poses special risks to women this is especially relevant for India where almost 50% girls are married off by the time they are 18 years of age.

Women have poor access to information and education which is critical in the context of HIV since behavior hang is the key to controlling the epidemic. This further accentuated among poverty stricken communities. Woman has poor access to health services as a result of lower priority given to their health and their lack of decision making powers within the family. Also women usually have poor mobility which inhabits access to information and services. Violence against women and HIV/AIDS continue to be inextricably linked rape, incest, assault by family members or friends. Violence in the course of trafficking or at work place exposes them to HIV infection.

“A-22 year old FSW (female sexual worker) in Shenzhen China who did not want to give her name said. She knows the risk but needs the work. “HIV/AIDS is the number one killer of my job. I cannot let this disease destroy my life. This is only a short term business. I don’t have any relatives in Shenzhen and can’t borrow any money. I can only relay on myself, I have to feed my children.”