AIDS (Acquired Immune Deficiency Syndrome) is a universal fatal disease and its mortality is 100%. In China, the number of patients with HIV (Human Immunodeficiency Virus) has been significantly increasing during the latest decades, excluding the unreported, untold, and unknown patients. HIV is almost found in every part of China, including thirty one provinces, municipalities, and autonomous regions (Wang, 2007, as cited in Zhao, 2010, p. 1). In February 2009, according to the official Chinese government report, there were 5,389 deaths led by HIV infection in 2008, which had become the leading cause of death caused by infectious disease in China (Ministry of Health, 2009, as cited in Zhao, 2010, p. 1). Chinese government shows great concerns about AIDS/HIV and keeps setting up new programs to help the people who suffer from HIV/AIDS, especially for those baby victims who get the virus from their parents. According to Zhao (2010, p. 1), with the commitment of Chinese government to enhance the national and international funding agencies for decreasing and preventing HIV/AIDS epidemic and providing HIV treatment and care in China. Moreover, those programs have resulted in a dramatic increase in the number of patients who are HIV-infected receiving antiretroviral therapy (ART) and the development of a national HIV care infrastructure (Zhao, 2010, p. 1).
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HIV is a single-stranded, enveloped RNA virus and it is one of the genes of virus called lentivirusses, which in the virus family called Retroviridae (Engelkirk, Duben-Engelkirk, 2011, p. 50). Also, it can recognize, attach and invade cells which have receptors and the most important receptor is designated CD4 and its receptor is called CD4+ cells (Engelkirk, Duben-Engelkirk, 2011, p. 50). Moreover, there are six regulatory genes in HIV, which are tat, rev, nef, vif, vpr, and vpu, and they can produce protein with needed information (National Institute of Allergy and Infectious Diseases, 2009). The protein can control the ability of HIV virus to infect a cell, keep producing copies of HIV virus, and causing disease afterwards (National Institute of Allergy and Infectious Diseases, 2009).
According to the Centers for Disease Control and Prevention of U.S. Department of Health and Human Services (2010), medical scientists identified the original source of HIV infection in humans is from a type of chimpanzee in West Africa, which could be the natural reservoir of HIV virus. Furthermore, when the people contacted with the chimpanzee decades ago, the simian immunodeficiency virus or SIV from the chimpanzee's body mutated into HIV when it got into humans' body through blood and it spreads to the other continents.
There are different approaches that people can be HIV-infected easily. The most common ways or more possibility to get the infection if someone is having unprotected sex with his/her partner is HIV-infected, or having more than one sex partners, having sexually transmitted diseases (STDs), sharing syringes, needles or other clinical equipment for injection, especially for those who are addicted to drugs, and mother-child transmission (Centers for Disease Control and Prevention, 2010). According to Barber, Gama, Dudaronek, Voelker, Tarwater, and Clements (2006, p. 963), the reservoir of HIV is the brain and the vector is the infected people but as mentioned above, the natural reservoir is the chimpanzee.
Speaking of China's situation, dirty needles with HIV virus are shared among injection drug users (IDUs) was the leading mode of transmission before 2007, particularly in the western and southern provinces which are at the Chinese border (Zhao, 2010, p. 1). This certain area in China is relatively poorer and many people living there are not highly educated. It is normal for the injection drug users to share needles because of poverty and lack of knowledge. The second large epidemic was caused by improper blood collection practices among plasma donors in several central China provinces (Wang, 2007; Zhang et al., 2008, as cited in Zhao, 2010, p. 1). The possible reasons for that could be lack of proper practice of nursing education system, lack of knowledge of blood donors, and lack of supervision by government. The current leading transmission of HIV in China is sexual contact, including migrant workers, men who have sex with men, and commercial sex workers (Wang et al., 2009, as cited in Zhao, 2010, p. 1). Due to globalization, China has become a less conservative and traditional country because there were no homosexturality or homoerotism years ago but it is still considered to be a negative behaviour today in China.
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In the early 1990s, illegal plasma donation by rural farmers in central China propelled the spread of HIV throughout the country (Wu, Liu, & Detels, 1995). Poor, rural farmers sold plasma repeatedly in unsanitary conditions as a way to augment their income, resulting in untold numbers of infection. Plasma donors sold their blood and plasma for small amounts of money, often repeatedly, as there were loose regulations or time enforcements.
Clinical Manifestations and Diagnosis
The signs and symptoms of different HIV-infected patients vary and there are several stages. According to National Institute of Allergy and Infectious Diseases (2009), during the first stages of infection, many patients will not have severe symptoms. This is the mean reason that people will not notice that they have already got infected by HIV virus. With one or two months, the patients may suffer from headache, tiredness, fever, and in the neck area, also, they might have enlarged lymph nodes (National Institute of Allergy and Infectious Diseases, 2009). At this stage, some patients are still unaware of their HIV infection because they think that they are just having a cold or fever and may not pay much attention to these mild signs and symptoms. In addition, these symptoms usually disappear with a week to a month, but during this period there are large quantities HIV virus in their blood and genital fluids (National Institute of Allergy and Infectious Diseases, 2009). Surprisingly, some people may have no symptoms for more than twelve years (National Institute of Allergy and Infectious Diseases, 2009).
After a longer period of time, severe signs and symptoms will be shown up because the immune system is severely weakened by the HIV infection. Base on National Institute of Allergy and Infectious Diseases (2009), those symptoms could be pneumonia, rapid weight loss, sore mouth, anus and genitals, extreme tiredness for no reasons, memory loss, depression, recurring fever, profuse night sweats, diarrhea that lasts for more than seven days, pink, brown, red or purplish blotches inside the nose, eyelids, mouth and on or under the skin, and enlarged lymph glands in different areas for a long period of time, such as neck, groin, and armpits.
There are various ways to get tested for the patients or the their babies to see if the person is infected by HIV virus. According to National Institute of Allergy and Infectious Diseases (2009), the patients can provide a sample of blood to do the blood test to check if it contains human antibodies specific to HIV. The two key types of HIV antibody tests are the Western blot and the enzyme-linked immunosorbent assay (ELISA).
On the other hand, getting tested for HIV before delivery is important to pregnant mothers. Mother-to-child HIV transmission will ruin the newborn infants' life. However, National Institute of Allergy and Infectious Diseases (2009) pointed out that it is not easy to determine if the babies are actually infected since they have been carrying the HIV antibodies for months from their mothers, who are infected with HIV virus. P. Liu, Shi, Wang, Yang, Li, Dai, Y. Liu, Sun and Pu (2008, p. 72) demonstrated that the widely used test method in China is the specificity and the sensitivity of the double-antigen sandwich enzyme-linked immunosorbent assay for HIV-Ab test.
In 1999, Antiretroviral (ARV) medications were firstly used in China and there were 150 patients received this medications as a clinical trial while another 100 patients purchased imported medications for comparison (Wang, He, Li,Yang, Chen, Fennie, and Williams, 2008, p. 72). The first Chinese ARV agent and AZT was produced by Northeast Pharmaceuticals August 2002, and in December 2002, DESANO Pharmaceuticals of Shanghai was manufactured three more ARVs: DDI, D4T , and NVP (Wang, et, al., 2008, p. 72). Two years later, six ARV drugs were made domestically for treatment in China, which were 3TC; NVP; AZT; D4T; DDI and EFV (Wang, et, al., 2008, p. 72). In addition, during 2002 to 2003, the Chinese government launched the China CARES Program for people living with AIDS and low income(Wang, et, al., 2008, p. 72). There is no HIV vaccination in anywhere around the world yet.
Role of the Nurse
The Chinese nurses are playing a crucial role in assisting doctors and health organizations to help HIV-infected patients. Since the population of China is huge and it is still a developing country, so it would be extremely challenging for nurses to take care of relatively larger number of HIV-infected patients compared to western countries and there are limited advanced treatment in China. Besides, in the rural areas, the conditions of health care system are extremely low as well as the natural environment is partially polluted and the many rural people are not well educated so they might pay little concerns about their health and performing hygiene. On the other hand, Chen and Han (2010, p. 3232) illustrated that Chinese nurses are frequently splashed by the patients' body fluid and exposed to needle sticks. However, due to educational factor and they are not fully aware of the potential risk of getting infected by HIV virus (Chen & Han, 2010, p. 3231).
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HIV/AIDS is a extremely harmful pandemic virus/disease but currently there is still not preventive vaccination produced. It is a serious global health issue and it requires international cooperation to develop an advanced treatment. China's HIV/AIDS epidemic spreads out quickly during these years because of unique Chinese economic, social, and cultural factors, the individual patient' particular experiences. The Chinese government, the health department, and clinical facilities and the whole society should all contribute to the HIV prevention program.