This report it will use the case study of David who is affected by long-term HIV-positive (sexual and reproductive health 2) and lives in the City Centre where he has an apartment. This case study it has been chosen because it essential to me as l have worked as a Nurse assistant for those with HIV- positive and l gained a lot of experience how to care for such patients. l was working in the hospital for so many years. He is facing an essential time in his life where he should consider making radical decisions, that could have impact in future life. This case study highlights David had to improve his health including, stop smoking, drinking and start eating healthy, always exercised and be devoted to his treatment programmed effectively. He was eased by him not to worry about his home any more. He managed to see his GP to get the medication needed. Within the care home where David was other service users were friendly and he had good friendship the service user known as Gayle. Then David was wondering why Gayle was not paying a visit until he had to visit Gayle that’s when he found out that one of the service users disclose about him being HIV-positive at a youthful age. David was unhappy about the situation then rung his sister for him to go back to his home. David was thinking that the care home would have good policies on and confidentiality and dignity. He was unhappy that the information was shared to the other service users. He also was alert that HIV- positive carriers a stigma within his generation, he felt unwell and vulnerable.

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Perspective on HIV health and illness

”The data for this paper were taken from study of 292 qualitative findings reports pertaining to chronic physical illness. The study findings team includes seven investigators and the author was principal investigator. Findings is a systematic analytic and synthesis study technique (Thorne; Paterson,1998). This is an interpretive qualitative finding approach within the researcher’s role is to understand how people put together knowledge about the major under study (Guba & Lincolin, 1994). Researcher’s analyse and synthesize what have been reported by researcher’s as studying, research design, and theoretical perspectives within qualitative research reports in an area to highlight similarities and differences among them and generate latest or expand theory about the major under study. There are two components analysis and synthesis. However, qualitative researchers have tried to focus on the analysis of primary research studying but analysis and synthesis are separate. This is to identify the commonalities, differences, patterns and themes. The technique is findings of the and influence of specific research and procedures in findings (Szmatka, Lvoglia &Mazur, 1996). Theory involves the major schools of thought importance in theoretical frameworks and emerging theory of primary findings, associated with theory to huge social context and assumptions (Ritzer, 1990). Focused research techniques can be used to networks, social influences on risk, and characteristics of settings that influence risk. Qualitative formative research also can be used to identify the meanings of risk behaviours, social goals of a target group, and valued prosocial identities or roles to link to intervention activities. The use of qualitative methods to explore daily routines or habits is also key for understanding social and environmental influences on behaviour and methods of risk reduction practices into daily life.”

HIV perspectives
”There are risk behaviours that are randomly distributed in a population and risk behaviours are generated and contributed via socially or environmentally structured social. This situation helps to discuss why HIV, with many other infectious diseases that spreads around the populations. In addition, social behaviours are rational based on some information, socially prescribed and behavioural decision making is based practical (March & Simon, 1959). The information grouped for decision making is from social via social control procedure and considering meaning of behavioural options and social rewards and punishments. For instance, partner choice is often focused on group particularly gender, age, ethnicity and structured factors for example, geographic location, migration patterns (Aral et al.,1999; Gregson et al.,2002; Youm&Laumann, 2002). The chose of partners way may result social rejection. Therefore, within the developing prevention interventions it is essential to start with an understanding of social and environment al influences on risk behaviours and social processes which promote and perpetuate these patterned behaviours.”

”Social perspectives on behaviour, social and environment and procedure through organisations, structures and individuals behaviours (Bronfenbrenner, 1979, Giddens, 1979,1984; Kelly et al.,2000; Trikett1997,2002). According to, the individuals which continually monitoring their social environments and reduce their behaviour focused on the social environmental information which they group (Kelly et al., 2000). ”Empowerment perspectives to HIV prevention generally aim to promote psychological, political, power among a target group as a mechanism for mobilizing collective action to promote health (Cohen, 2004; Hays et al., 2003; Jana et al., 2004; Zimmerman, 1995). Empowerment interventions are often designed to promote positive aspects of identity of low status or stigmatized groups to affect behaviour change among the group. Empowerment interventions can strengthen network ties that redefine and enhance meanings of social identities, such as HIV positives and commercial sex workers (Jana et al., 2004). However, not all risk groups share a salient social identity that is amenable to promoting in empowerment interventions (Mays et al., 2004).”

Bio-psychosocial perspectives in HIV
”The various of symptoms presented by patients with AIDS is the same as symptoms shown in cancer. The pain may have associated to the direct affects of HIV on the central nervous system, immunosuppression (Hewitt D McDonald M Portenoy R et al 1997). However, HIV is a very painful condition, that affects up to 30% people with HIV. HIV infection and advanced AIDS these are related to peripheral neuropathy that is more frequent neurological complication. It has been specified that there are 6 patterns of HIV related peripheral neuropathy, though diagnoses are always being misdiagnosed (Swanson B Zeller JM Paice JA1998). A current finding it examined the impact of HIV infection on primary reports unmissed study such as HIV infection that related with decrease in migraine frequency and intensity. Altering within primary headache were related with stages of infection and with encephalopathy, but not with CD4 count. Furthermore, these writers found an increase in tension type of headache during HIV infection progression.”
”The dominant theoretical model in the chronic pain literature is a biopsychosocial model. This perspective emphasizes the multidimensional nature of the experience of chronic pain that includes structural pathology presumed to be responsible for nociception, the experience of pain itself, and associated functional limitations and affective distress. Attention to each of these dimensions is presumed to be important in adequately character hgrizing the experience of pain. For example, it has been argued that the dimensions of disability and distress should be considered primary, rather than secondary, dimensions of the experience because of high rates of co-occurrence among individuals reporting persistent pain, direct associations with reduced quality of life for these individuals, and socioeconomic implications ”(Breitbart W, 1999)”.

The contribution of theories of HIV
”However, model confirms what seems to be intuitively obvious: sexually active persons can reduce their risk of acquiring HIV by choosing a partner who has tested negative for HIV, by choosing sex acts that are less likely to transmit HIV infection, or by choosing to use condoms. However, many persons engaging in risk-related behaviour have misconceptions about the risks of different behaviours. Wenger NS, Kusseling FS, Shapiro MF, 1995 Estimates of the magnitude by which different choices might reduce the risk of HIV acquisition could help individuals make more effective choices about behaviours that reduce their risk”.

”Though, individual’s choices of partner and sexual behaviour are based on both the risk of acquiring an infection and the benefits derived from the sexual relationship. Our model indicates that the choice of partner is the most key factor determining the risk for HIV infection. However, individuals often rely on implicit theories about their partners’ personal characteristics or social networks to determine their level of HIV risk, and they do not ask about their partners’ HIV status. Misovich SF, Fisher JD, Fisher WA, 1997 this self-assessment of risk might be of value, because choosing a “safe” partner over a “risky” partner can reduce risk of HIV acquisition. For example, for a heterosexual man, having sex with his wife is a lower-risk activity than having sex with a commercial sex worker. However, it is often difficult to assess a potential partner’s risk Hoffman V, Cohen D. A, 1999”.

”Furthermore, model illustrates that choosing a partner who has tested negative for HIV reduces risk 47-fold, compared with the risk associated with choosing a similar partner of unknown serostatus. Ensuring that a partner is HIV-negative can be one of the most effective strategies for prevention of HIV infection. Many couples have recognized the value of this approach and seek HIV testing together. In addition, having a partner in a mutually monogamous relationship undergo retesting is another effective risk-reduction strategy, because a repeatedly negative test nearly eliminates any chance that the partner is infected. Promoting discussion of HIV status with prospective sex partners should be a vital component of HIV-infection prevention efforts. New HIV testing technologies could further facilitate the acceptance of this approach by allowing persons to receive test results more quickly or even test themselves at home.”
”Though, a safer sex act is another way to reduce risk. This approach seems to have been adopted by many homosexual men who have more oral sex and less anal sex than in the past. (Schacker T, Collier AC, Hughes J, Shea T, Corey L., 1996) We believe our risk hierarchy for sex acts is in the correct order, although the magnitude of the differences in their risk is uncertain. Our estimates of the relative risk were based on odds ratios that were calculated primarily from cross-sectional data. (European Study Group, 1992) Accurate estimates of per-act relative risk are difficult to determine because investigators cannot recruit sufficient numbers of people who practice only certain sex acts and cannot ensure the absence of other infected partners. Furthermore, studies that follow discordant couples are associated with biases because investigators start with couples who have been sexually active without transmitting infection and exclude contacts during primary HIV infection. (Mastro TD, de Vincenzi I.,1996) Thus, it seems unlikely that the estimates of risk of HIV infection associated with specific sex acts will be much more accurate soon.”

”It is important to note that we estimated the risk for HIV infection during a single act. When multiple acts over a period are considered, frequency of sex and number of partners are important contributors to cumulative risk. In this context, choosing safer sex acts could lead to other behaviour changes that increase risk. (Schacker T, Collier AC, Hughes J, Shea T, Corey L., 1996) For example, oral-genital contact may be less efficient at HIV transmission than other sex acts, but if oral sex is practiced more frequently or with risky partners (because it is perceived to be safe), it could increase the risk for HIV infection. (Schacker T, Collier AC, Hughes J, Shea T, Corey L.,1996) Similarly, having a larger number of partners increases the likelihood of exposure to an infected or highly infectious partner (Centers for Disease Control and Prevention., 1999)”

”However, condom use has been the mainstay of HIV prevention strategies. The literature suggests that consistent use of condoms can reduce HIV transmission by 85% to 95%, but most study findings suggest that increasing the effectiveness beyond 95% will be difficult because of slippage, breakage, and incorrect use. (Pinkerton SD, Abramson PR.,1997) (Davis KR, Weller SC.,1999) In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%. 42,43 Data from a cross-sectional study suggested that condoms failed 13% of the time, resulting in potential exposure to STDs, including HIV.”

”Though, study has some limitations. First, we did not consider parenteral exposures, such as those for injection drug users or health care workers. Even for the sexual transmission group, we did not include risk estimates for cunnilingus because almost no information is available on the risk of this sex act versus that for other sex acts. Second, we did not consider other factors that might influence risk of HIV transmission, such as varying infectivity in stages of HIV infection, viral load, circumcision status, and concurrent STD. (W Gray RH, Wawer MJ, Brookmeyer R, et al.,2001) also did not consider the influence of drugs and alcohol on individuals’ ability to make choices. Third, choosing a partner who has tested negative for HIV or choosing a safer sex act does not necessarily protect against STD or unwanted pregnancy. Fourth, our estimates of the prevalence of HIV among potential partners (1–10%) would vary greatly for different individuals. While this would have negligible effect on the relative risk reduction associated with different choices, it would change the absolute risk for HIV infection. Finally, us per-act absolute risk estimate for receptive vaginal sex was based on a model that assumed constant infectivity and the same risk over all sex act Centers for Disease Control and Preventions. (Nicolosi A, Leite LC, Musicco M, et al,1994) her studies have provided a wide range of estimates (13%) based on different populations and different models, Mastro TD, de Vincenzi I, 1996 which would change the absolute risk but not the relative risk estimates’. ‘We believe these estimates will help people better understand the risks for HIV infection that are associated with different choices. Individuals could eliminate all risk of sexual acquisition of HIV by eliminating all sexual contact. Short of that, any sexual contact brings some risk of infection and some pleasure.”

The advocacy for individuals having long term illness like David refer to the case study.

”This type of advocacy has been described as standing invitation to be clever at someone else’s expense’ (Harvey (1958 in Pannick (1993). A helpful definition of advocacy is it is a ‘compliment to impact the balance needs / rights of the group in the favour of the needs or rights of singles, especially those on the social margins’ (Brandon 1995). An interesting of collective self-advocacy has been the Nottingham- based Advocacy in Action group (Small 1991). He highlighted this aspect of the role of the social worker in addressing social injustice (Attlee 1920). Advocacy pursue to represent the interest of powerless clients to powerful singles and social structures’ (Payne 1997). Payne also usefully report the place of advocacy in social work practice. Davies goes on to relate two forms of advocacy in social work: personal advocacy and structural advocacy. However, Coulshed another writer on social work theory, places and advocacy among the skills to be when trying to obtain capital for a client (Coulshed 1991). He also narrates a useful theoretical framework for all advocacy, not just that handle by social workers. Where groups are arranging towards unity rather than to one sided of the story, then including other elements.’ (Coulshed 1991).”

”Advocacy has always present within one form or another. For instance, throughout history of parents, friends, members of the community and practitioners supporting people to ‘be heard’ and achieve their quality of life (Rolph et al., 2005); Mitchell et. al.,2006). However, formal advocacy-represent through the foundation of advocacy company, funded by advocacy plan and the right to permitted advocacy for some groups of people is most happening. However, there are some people whom marginalisation and disempowerment an ongoing and everyday part of life are. Indeed, the advocacy ‘movement’ was born out of the institutional scandals which were uncovered within the 1960s and 1970s (Henderson and Pochin, 2001), and grew within agreement to the deficiencies which proceed as people were moved from centre into the community (Barnes, 2007). Henderson and Pochin (2001) they suggested advocacy fulfils various purposes. They argued that, among other things, advocacy has the aim of assisting people to improve the followings: acquiring the ability to pursue a choice by removing barriers, brace people to access the applicable information and experiences to know what their choices may be and correcting wrongs that has imposed on people.”

”However, there are types of formal advocacy including: single advocacy that refers to a one-to- one relationship between an advocate spokesperson and their disadvantaged partner (Atkinson, 1999, pp.6). A good deal of advocacy are volunteers, although some advocates are also organised, supervised and trained whereas other advocates might be in paid roles. Single advocacy includes the growth of an advocacy union which lasts months or years, usually report as ‘citizen advocacy’. Sometimes the advocates would have a caseload of people for whom they are providing help on a short-term basis, to deal with problems. This is known as ‘casework advocacy.”

”However, single advocacy takes peer advocacy. It is when the advocate is an ‘insider’ -this is someone who knows via personal issues how it is to live with a specific has experience of the health and social care system. The individual advocacy might also take emergency advocacy, that deals with one off crisis, for instance helping a person being discharged from hospital, or assisting someone to deal with serious paperwork, like mounting bills. In recent years, single advocacy had also been made present on a required basis within certain situation. For instance, following the passage of the Mental Capacity Act 2005, the government introduced Independent Mental Capacity Advocacy within England focusing important conclusion about their health and social care, lack capacity and not able to speak by themselves. Again, from 2009, people subject to confirmed aspects of the Mental Health Act 2007 within England and Wales had access to Independent Mental Health Advocacy (IMCA). Added, self- advocacy this is to talk about oneself, most closely related with disabled people, with learning disabilities, and survivors of the mental health system. However, many self -advocacy company are also appearing among service user including people with HIV/AIDS.”

Conclusion and recommendations

To conclude, David situation of the above he should have the professional working close with him as soon as it was announced about his divorce in the late 40s. I suggest he should have had an advocate that was speaking, guiding throughout his challenges that he faced with short term, drinking, one-night stand and guide him to be focus with a long-term relationship. However, it shows that woman got to involved after his divorce were not helping the situation to settle as well. It shows that he was vulnerable. He had his own flat as well that did not help because he used to live alone. He was suffering fatigue for many years and he used to play golf as well. Even though, current his sister had to intervene to provide more care. We can assume he probable he could not handle divorce issues well, though it does not highlight made them to divorce with his wife. It does not specify how long they have been married in this case study. That could have been the significant impact in his life that altered everything to in his health the way he was carrying himself. Usually when you are not happy in life we tend to replace our happiness with other things that can help to be happy in that short time. Such as drinking a lot, going out, having sex with various woman without thinking about it. Though, he tried to improve his health diet. However, the situation for David it became to point where he thought the sister was agony with his illness. He then started to plan that he should let his flat and go and get to be cared for in a care home. There was a point when he was not happy about a care home because of the way handle the dignity, privacy, confidentiality and still carrying the stigma about the HIV individuals. He really was agony about how they got to expose his situation about his illness that he did expect in care home according to their rules and regulations.


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