Health Promotion Proposal I

Health Promotion Proposal I

Roberto E. Gimenez

Health Promotion Proposal I

Human Immunodeficiency Virus (HIV) is an infection that left untreated, leads to Acquired Immunodeficiency Syndrome (AIDS). AIDS leads to premature death. In the United States, an estimated 1.1 million people are infected with HIV. Testing helps the infected people to begin treatment and taking care not to infect others (Centers for Disease Control and Prevention, 2010). However, a research conducted by the Centers for Disease Control in 2010 indicated that over 50% of America’s total population has never had a HIV test. HIV and AIDS have been identified in varied studies as the leading health indicator in Florida. Prevention measures have also faced various hurdles in different parts of Florida.

The same research indicated that every 9.5 minutes, a new person gets infected with HIV. These figures demonstrate a crisis that needs to be mitigated without much delay (Centers for Disease Control and Prevention, 2010). HIV prevention and detecting at early stages can save a lot. First, prevention would ensure less people get infected. Early detection would lead to early treatment. Early treatment in turn would ensure; there are fewer cases of AIDS which is more costly to treat and results in many deaths. Both measures save on cost. Programs such as ECHPP initiated in Miami-Dade County targeted creating awareness on the importance of testing and prevention measures.

The proposed health program is based on the above mentioned strategies of HIV prevention and HIV testing and early treatment. The target area is South Florida, particularly the hard-hit Miami-Dade County. The program will emphasize, on encouraging residents of Miami-Dade to be tested regularly (Sanchez et al, 2008). The people who will test positive should begin receiving treatment immediately to prevent the HIV developing to AIDS. The plight of the vulnerable groups of people is addressed in the program and suggestions given for each. Other issues such as HIV-related stigma are also considered in the program (Villar et al, 2011). The program will focus on an individual’s effort towards HIV prevention with the support of health care centers.

There are groups with higher HIV prevalence than others. For example, there was found to be a higher rate of AIDS in the Northeast and South states, which also have large populations than in other parts of the United States. This was according to data released by the National HIV Surveillance System in 2008. A study done in 2006 indicated HIV and AIDS as the leading cause of death among Blacks in Miami-Dade County.

One vulnerable group is the Latino immigrant workers. About half of Miami-Dade residents are foreign born, an indicator of massive migration. Migration has accelerated spreading of the virus across borders. These movements decrease their accessibility to health services since the host country may not be keen to address the needs of immigrants (Brown, 2002). Immigrants face racial or ethnic intolerance in host countries. This may facilitate their hesitation to declare the HIV status for fear of stigmatization. The instant separation from family and social circle may result in psychological stress and consequent high risk behavior. The case of illegal immigrants is complicated because they avoid contact with any government agency including health centers. The proposed program intends to help them overcome stigmatization. They will be linked to social groups formed by people with similar challenges where they can share freely, as well as overcome their fears and gain self-confidence. Information about the care centers available in Miami-Dade where they can get medical attention without fear of non-citizen discrimination will be availed.

The Black community is also a vulnerable group particularly in Florida. Over 51% of the HIV/AIDS reported cases in Miami-Dade, in 2005, were Blacks. Though the Blacks only constitute 20% of the Miami-Dade’s population, they account for 60% of HIV/AIDS related deaths. Miami-Dade County Health Department released a report addressing the Black community issues (Spencer et al, 2006). The high HIV/AIDS prevalence was attributed to the fact that most Blacks could not afford to pay for routine check up’s. The Black community needs to be aware of their high prevalence. This awareness creation will be part of the proposed health program as well as ways to mitigate this high risk situation.

Homosexuals have a high rate of HIV infection. Women need regular testing during pregnancy to prevent mother-child HIV transmission. Women in some parts of the continent are made particularly vulnerable due to suppression by culture and beliefs. For instance, Hispanic women in the Caribbean countries should not discuss sexual matters. This affects the strategies that have been used before to elevate awareness of testing and preventing AIDS. To overcome this challenge, the strategies to be used in this program will be more interactive. Education will be customized in light of the cultural setting of Miami-Dade County.

Efforts have been made to mitigate the high risk factors such as the ones above mentioned. The New Opportunities for Women en espanol was a project that was guided by Miller School of Medicine. It targeted overcoming the cultural barriers of sexual silence among Hispanic women. The issues discussed with the participants included HIV and sexual risk, sexual protection and negotiation with sex partners (Sanchez et al, 2008). The project also pointed out the high rate of HIV/AIDS stigmatization among the Hispanic community.

A Cultural Competency Program was conducted in 2003. The program faculty was Florida International University of Nursing and Barry University School of Nursing. It was a training program, for nurses to help them understand the prevailing culture and beliefs as they administer health assistance (Sanchez et al, 2008). HIV prevention messages that are effective in other parts of America were found ineffective in creating the same awareness in the Caribbean countries. HIV intervention programs would need to consider the linguistic and cultural aspect of this area.

Health Promotion Proposal

The proposed program is informed by the reigning statistics pertaining to the prevalence of HIV/ AIDS among the immigrants, black Americans and Hispanics. It acknowledges that efforts to combat the epidemic would have to be three-pronged where the society participates in the efforts, alongside the healthcare providers. Government or institutional participation would also be required in combating the high prevalence. This is especially considering the barriers that have been standing in the way of the highly affected groups in searching for proper medical attention. As stated, the prevalence of HIV/AIDS is highest among some societies such as the blacks, Hispanics, as well as homosexuals. In essence, the proposal must encompass strategies that would eliminate the barriers that hinder them from seeking proper medical care or that increase the prevalence.

The proposed program targets HIV awareness and prevention among immigrants, Blacks, gays and women in South Florida. Borrowing from what has been done previously, the program will employ education as the strategy to reach out to each group (Villar et al, 2011). Within a year, the program aims at having new data for each group relating to their level of HIV awareness, testing and prevention. A sample will be taken, from the various target groups to be used for the survey. Actions will be derived from the report of the intended intensive survey. The program will emulate the Enhanced Comprehensive HIV Prevention Plan (ECHPP) used by Florida’s Health Department. It is consistent with the National HIV/AIDS strategy and incorporates women, African American, migrant workers and transgendered people and drug users.

The health promotion proposal would start with enhancing cultural competency among the healthcare professionals. Different individuals from different cultural backgrounds subscribe to different beliefs and values that often inform their decisions on everything including healthcare services (Dyer, 2003). Research shows that the active participation of individuals in their own healthcare would be determined by how much they can identify with the healthcare providers. As much as individuals would not demand that their healthcare providers be specifically from their cultural groups, they would identify more with providers who seem to consider their cultural values and respects them (Purnell, 2008). Unless healthcare providers understand the cultural values to which the Hispanics and Black Americans subscribe, they would be unlikely to be effective in having any impact on their healthcare decisions (Purnell, 2008). IN essence, the varied healthcare providers should be taken through cultural competence training pertaining to the cultural groups within which they practice. This will enhance their knowledge on the values of the different cultural groups within which they practice, thereby enhancing their effectiveness (Dyer, 2003). These cultural competence courses should be administered within 3 months.

On the same note, it is proposed that a comprehensive education campaign is carried out specifically targeting the groups that have high prevalence rates. This education would mainly target the Hispanics, immigrants and Black Americans, with the sole aim of rebuffing the cultural beliefs that hinder them from seeking medical attention, especially with regard to sexuality. On the same note, it is proposed that healthcare providers undertake community mobilization so as to establish environment that support prevention of HIV through the active involvement of community members in efforts that would build support for and participation in efforts to prevent HIV, raising HIV awareness, as well as motivation of individuals to eliminate HIV stigma. Educational campaigns would also target women in black and Hispanic communities in an effort to encourage them to take charge of their sexuality.

The third strategy involves institutional changes within the healthcare sector. It is imperative that healthcare providers install at least two condom dispensers for every block. This would allow individuals, irrespective of their cultural background or citizen status or economic station, to obtain the condoms and practice safe sex (Jones et al, 2002). As much as there are varied way in which individuals could become HIV positive, unsafe sex has been cited as the key culprit. This could also be complemented by the provision of free ARVs (Anti-Retroviral drugs) in the healthcare centers. These provisions coupled with education in the communities about the importance of practicing safe sex and being faithful to one partner, would go a long way in slowing the infection rate (Malow et al, 2000). These should be installed within a month’s time.

It is recommended that clinical settings incorporate routine opt-out screening services for HIV offered to patients aged between 13 and 64. This is the age-group that has the highest prevalence rates in the country. These screening efforts could be expanded to non-clinical settings within a year so as to detect undiagnosed cases of HIV.

Potential Barriers & Challenges

As is the case for every initiative, this initiative is expected to meet a number of challenges. This is especially considering that sexuality is still a taboo topic among some groups such as Hispanics (Malow et al, 2000). It is expected that the targeted communities would be relatively disinterested in participating in the education campaigns. On the same note, the financial burden especially with regard to provision of free condoms, as well as ARVs is a significant challenge for the initiative. However, the financial challenges could be combated through collaboration with government agencies, corporations, as well as private entities. On the same note, seeking for sponsors in the corporate world would be helpful in combating the financial challenge (Malow et al, 2000). The disinterest of the public in the educational campaigns would be combated through collaboration with community help groups and organizations. These are seen as less rigid and are likely to have gained more acceptance among the communities especially due to their non-alignment with government agencies (Jones et al, 2002).

Intended Outcomes and their Evaluation

The strategies outlined are, on the whole, aimed at eliminating the barriers to the seeking of treatment among the varied groups in Miami. It is expected that these efforts will decrease the rates of new infections and increase the numbers of individuals seeking healthcare services for HIV/ AIDS (Jones et al, 2002). In addition, it is expected that women in the targeted communities will be participating in these campaigns and coming out in large numbers with time. Their infection rates are expected to decrease with time. Different but closely linked results would be used in measuring the effectiveness of the proposed strategies.

The increased awareness education would be measured using data pertaining to changes in the number of individuals who seek screening services.

The installation of dispensers, provision of free ARVs and the incorporation of routine opt-out screening services for HIV offered to patients aged between 13 and 64 in clinical and non-clinical setting would have its outcomes measured using data on the number of individuals who seek screening services, as well the decreased rates of new infections (Walton et al, 2004). The comprehensive education campaigns would have their outcomes measured through the increased number of HIV infected individuals coming clean about their health status and the increased participation of such individuals in the campaigns and education. It is expected that more individuals will come out to be tested and even take up the treatment (Walton et al, 2004). This data will be obtained after every six months, so as to get the differences in the number of new infections and any changes in the same. It is expected that there will be a decrease in the numbers of new infections, with more individuals seeking treatment. The goals of the proposal will be attained through decreased rates of new infections.

References

Brown, E., (2002). Recruitment Feasibility and HIV Prevention Intervention Acceptability Among Rural North Florida Blacks. Journal of Community Health Nursing, 19(3).

Centers for Disease Control and Prevention, (2010). Vital Signs. Retrieved from HYPERLINK “http://www.cdc.gov/vitalsigns” http://www.cdc.gov/vitalsigns

Dyer, J. G. (2003). The black cloud over the Sunshine State: Health disparities in South Florida. Journal of Cultural Diversity, 10(20), 50-55.

Jones, S. G, Messmer. P R., Charron, S. A., & Pams, M. (2002). HIV-positive women and minority patients’ satisfaction with inpatient hospital care. AIDS Patient Care and STDs, 16(3), 127-134.

Malow, R. M., Cassagnol, T, McMahon, R., Jennings, T. E., & Roatta, V G. (2000). Relationship of psychosocial factors to HIV risk among Haitian women. AIDS Education and Prevention, 12(1), 79-92

Sanchez, J., Suarez, G., Serna, C., & Rosa, M.D. (2008). The Latino Migrant Worker HIV Prevention Program: building a community partnership through a community health worker training program. Fam Community Health, 35(2).

Purnell, L. (2008). The Purnell model for cultural competence. In L. Purnell & B. Paulanka (Eds.) Transcultural health care: A culturally competent approach (3rd ed., p. 25). Philadelphia: F.A. Davis, Co.

Spencer, L., S., Trepka, M., Liberti, T., Cohen, L., & Romero, J. (2006). HIV/AIDS patients who move to urban Florida Counties following a diagnosis of HIV: Predictors and implications for HIV prevention. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 83(6). doi:10.1007/s11524-006-9128-4

Villar, O.M.L., Vamos, S., Jones, D.L., Lopez, E., & Weiss, S.M. (2011). A cultural perspective on sexual health: HIV positive and negative monolingual Hispanic women in South Florida. Hispanic Health Care International, 9(2).

Walton, D. A., Farmer, P E., Lambert, W, Leandre, F, Koenig, S. P, & Mukherjee, J .S. (2004). Integrated HIV prevention and care strengthens primary health care: Lessons from rural Haiti. Joumal of Public Health Policy, 25(2), 137-58