HIV and AIDS Prevention in Jacksonville, Florida

Community health clinical Time log 

Prevention and control of HIV using social media campaign program 

Date	Activity	Location and contact	Hour	Relevance to topic
6/12/2017	Jacksonville survey	Duval county ,Jacksonville	10	Gaining understanding of the demographic nature of the city
7/12/2017	Social and cultural survey	Jacksonville	10	Assessing the cultural and social lifestyle of the target population
8/12/2017	Surveying the economic status	Jacksonville	10	Assessing the economic status and living standards of the target population
9/12/2017	Assessing the resources of the community	Housing facilities, health facilities in Jacksonville	5	In the survey, the city has very health facilities. Most people are homeless.
10/12/2017	Assessing city resources	Nutritional level in Jacksonville	5	Due to high level of poverty, the level of nutrition of the residents is poor
11/12/2017	Surveying the city	Population composition by gender, race and age in Jacksonville	10	In the population, majority are African American
12/12/2017	Reviewing the health statistics and the rate of HIV infection for last 3 years	Getting the HIV infection data from Jacksonville	10	Statistics shows the city is the third highest in HIV infection. Possible reasons being due to poverty level
13/12/2017	Interview: possible causes of HIV	Health expert from Jacksonville	1	Dr. James believes the major cause of HIV in the city is poverty
14/12/2017	Interview: level of HIV awareness	Private practice doctor, Jacksonville city	1	Dr. Washington is of the opinion that the level of HIV awareness in Jacksonville is still very low
15/12/2017	Attending the city health officials meeting	Meeting at the city hall, Jacksonville	8	The meeting was called to discuss ways of improving the health facilities in the city
16/12/2017	Interview: death rate due to HIV infections	Assessing the number of deaths in Jacksonville due to HIV. Interview with clinical officer.	1	Madam Jane believes the death rate due to HIV infections stands at 10%
17/12/2017	Interview: rate of stigmatization due to HIV	Assessing the stigmatization rate in Jacksonville. Interview with a resident.	1	Mr. Donald assures that there is high rate of stigmatization in the city and many people are unwilling to speak about HIV .
18/12/2017	Assessing the relationship between poverty level and HIV spread through field study	Florida state, Jacksonville	10	From the assessment, high levels of poverty is one of the major causes of the increasing HIV infections in Jacksonville city
19/12/2017	Surveying: possible impacts social media campaign could have on the spread of HIV and behavior change	Jacksonville	8	From the survey, social media campaigns can impact positively on the spread of HIV by creating awareness among individuals who are at risk.
		Total hours	90

Jacksonville is the largest populated city in the U.S. state of Florida. It also forms the largest city by area square in the United States. According to Magill, S. et al. (2012) , Jacksonville had an estimated population of 913000 by the year 2017. The metropolitan area has a population of 1,626,611, becoming the fourth largest in Florida. Jacksonville is located at the center of the banks of river St. Johns, about forty kilometers to the south of Georgia State and an estimated 340 miles to the north of Miami. The City has a population density of about 1100 people for every square mile. According to the census that was conducted in 2010, the composition of Jacksonville by race was found to be 59% whites, 31% being African American and 8% being Hispanic. Jacksonville is considered the home to the tenth highest Arab population in the United States while at the same time serving as the home to the largest Filipino American community in Florida. Jacksonville’s largest religious group is the protestant, with Evangelical Protestants constituting 365,000, mainline Protestants making up of 76,000 and 57,000 being the black Protestants ( Patel, P.et al., 2012) . The population growth rate has been estimated to be 2% since 2010, becoming the twelfth most populous city in the United States. Due to its increasing population, there has been an increase in the economic activities as well as social activities among the people. 

According to the AIDSVu, a project of the Emory University School of public health in partnership with GileadSciences, Jacksonville city has the ninth highest rate of new HIV diagnosis in the United States. In their findings, AIDSVu indicated that out of those who were infected with the disease, 65% were male while 35% were female. Also in the statistics found by the research body, the most infected population were black, which constituted 64% of the whole infected population while the whites represented 27%. Further, in the reports, 1,916 people died of HIV in the year 2014, and a sharp increase to 2616 in the year 2015. Every year, the city reports an increase in the new infections with men leading in the new diagnosis at 72%. The estimated number of new HIV diagnosis, 2012-2015 are as shown in the graphs below. 

Fig. 1.1. 

From the graph above, it is evident that the rate of new HIV infections in the Jacksonville has been on the rise for the last four years. This information is also supported by the Centre for Disease Control and Prevention and the Census Bureau. According to the national publication known as Rolling out.com, Jacksonville has the third highest HIV infections in the country after Baton and Miami. 

As a result of this worrying statistics about HIV infections in Jacksonville city and rapid increase in the death rates, there has been a rising need to come up with a prevention and control program to help monitor the rate of HIV spread in the city and to help save the lives of thousands of the residents. While many researchers and scientists have put their focus on the need to control the increasing rate of chronic diseases among the homeless individuals in Florida, very few attention has been paid to the high number of HIV infections in Jacksonville. This research, therefore, focuses on the need to prevent and control the spread of HIV among the residents of this city through awareness creation using social media and other relevant means to save the lives of many other individuals who are at the risk of being infected. The target population is more than a third of the Jacksonville residents who have been infected with HIV as well as the remaining society that is not infected. 

The city that has a larger population of African American individuals is disproportionately affected by the high rate of poverty and inequalities in accessing other essential social amenities including health care. According to the statistics from research by Census Tract (CT), a significant percentage of the residents in Jacksonville city are poor while others are homeless. They are low-income earners who are at the same time socially and environmentally disadvantaged. The poverty levels range from 5% to 55%. This poor population is unable to receive a better education, better nutrition as well as proper health care. Due to lack of appropriate school as a result of poverty, these individuals don’t have the required knowledge necessary to control the spread of HIV/AIDS. As a result, the majority of the population contract the disease and die from it because they at the same time don’t have enough resources to seek better medical services. In Florida State, better medical services are dependent on one’s ability to pay for it at the best hospitals. Majority of the Jacksonville being poor, they are unable to access these better hospitals and as a result the cause of high death rates due to HIV/AIDS. Economic disparity in this city leads to health disparity because better healthcare services are heavily dependent on one’s financial or economic status. 

Duval County where Jacksonville is located is not homogeneous. The county is divided into Health Zones (HZ), where the population of each zone varies in social-economic status, education and demographics. For example, the population of HZ6 is made up of 16% minorities while and 81% of the HZ1 are minorities. These existing social and health disparities are prevalent and vary from one zone to the next. According to the data from the Point-in-Time Count of 2014, the majority of the population from each of the zones are homeless, making it a challenge for them to live a healthy life or even access better medical services. 

Jacksonville city and Florida as a whole has set up HIV/AIDS Hotline in the statewide resources program for HIV/AIDS-related information, supportive telephone counseling as well as community referrals. The Hotline is useful to callers who receive specific information related to HIV/AIDS among them being the testing sites and counseling for the victims. It has been a significant step in trying to control the increasing spread of HIV/AIDS in Florida. Although the program has made significant achievements in controlling the spread of HIV/AIDS, the number of deaths arising from the fatal disease in the city has not changed significantly. This is due to people’s unwillingness to call the Hotline seeking help because of the fear of stigmatization. Other resources in place to help control the disease are the opening up of many free counseling and testing centers within the city to encourage many people to get tested and know their status. This has been accompanied by a program known as APO which works with a combination of scientifically proven and cost-effective interventions directed towards the population the risk of being infected with HIV. The focus of this program is to serve the HIV-infected individuals as well as those at risk of the infection, connecting them to care and treatment while at the same time providing interventions to improve medication adherence and risk reduction. Another resource available in the city is the Positive Healthcare, an organization that assists those with HIV/AIDS in accessing resources to help them in their management of the disease. 

According to Ackers, M. et al. (2012) , one of the major causes of the increasing new HIV infections in Jacksonville is the high level of poverty in the city. The residents have low income while others are homeless, making them unable to live a healthy lifestyle or even get access to better medical services. As a result, the spread continuous and death rate goes up. Also, lack of proper medical funding has been mentioned as being among the causes of the ever increasing HIV infections in the city. An infected individual being unable to access medical services, continuous to spreads the disease to others, making it difficult to control. According to Northeast Florida AIDS Network, a non-profit making organization that helps people living with HIV, the stigma of the disease is another cause of the continuing spread of the disease. Nobody is willing or wants to talk about the condition due to fear of stigmatization. Majority of the infected individuals remain silent with their situation, and the spread passes on from one person to another. These are the main reasons for the high HIV infections in the city. 

Evidence-based practices in controlling the spread of HIV are those practices that on rigorous evaluation have demonstrated success and positive impacts. The evidence-based practice that has shown to be successful in controlling the spread of HIV in the provision of resources for nurses and training them in the core competencies for HIV nursing care ( Burns, N., & Grove, S. K. 2010). Results have shown that training nurse and giving them resources necessary to handle the HIV patients care has helped harnessed the control of the spread of HIV. According to USAIDS, offering appropriate training and the resources required to offer care to the HIV patients have helped reduce the spread of HIV infections by 7%. Another best practice that has been proved to reduce the rate of HIV prevalence is the Centers for Disease Control and Prevention (CDC). Since the introduction of the program, the rate of HIV prevalence has reduced significantly, making the CDC program an evidence-based practice in controlling the spread of HIV/AIDS. 

Developing a community health nursing social media campaign can be used to educate the community on how to combat the spread of HIV infections among individuals ( Wakefield, M. et al., 2010) . Given that technology has rapidly advanced and almost everyone is in social media, nursing social media campaign can be a useful way to reach the majority of the population including the low-income individuals. The objective of the social media campaign is to expand the reach by accessing the majority of the population and offering education and counseling on how to avoid, manage or control the spread of HIV. Through the social media campaign, the clinical officers and nurses will be able to communicate with the youths on various matters concerning the spread of HIV. It will also aim at reducing stigma among people and encourage them to open up and boldly speak about the disease that has become a disaster in the city. 

The recommended population that the social media marketing will focus on are the youths and women who are at high risks of contracting HIV/AIDS. The social media campaign will target this group of people because the majority of the youths are found in either one or all social media platforms. This will make it easy to reach a broad population with the intended message, and thus a positive outcome will be realized. The major social media platforms that can be used include Facebook, Twitter, blogs, and YouTube. Facebook is beneficial in this initiative because the platform has millions of users making it easy to have broader coverage. Twitter, YouTube, and blogs are equally helpful because of the high number of users in the city, giving more extensive coverage. 

The target population; youths and all the individuals who are at risks of being infected with HIV will benefit from this social media campaign program through obtaining education on the best ways to improve their lifestyle and stay away from the risks of being infected. The message will also help the target population to avoid stigmatization against the infected individuals and instead encourage the society to speak about the disease and measures to control it openly. The social media platforms will also offer counseling and advice to the individuals who are at risks of being infected and teach them how to stay safe and healthy. Also, the target population will be informed of the various locations at which they can go for testing so that they can know their status and start treatment where necessary. 

A recent study shows that 55% of the patients’ decision to seek treatment at a medical facility is majorly influenced by the social media connections, indicating that patients have trust on the information they receive from social media ( Wei, C. et al., 2011) . One of the best practices for implementing a social media tools for health marketing is by engaging with patients in real time. It is achieved by enabling deeper and more meaningful discussions that address the patients’ queries and concerns. Another best practice is to listen to the audience online and understand what worries they have. Upon realizing the interests of the audience and what they need, dig deeper and look before offering a solution. It can also be achieved by analyzing the metrics of the social media and online audience and integrating it into other tools such as customer relationship management. Best practice can also be obtained by engaging the targeted population with people from their community on social media. People are more likely to trust members of their community than outsiders. When the members of the same city are the ones selected to spearhead the social media health marketing, it will have a more significant impact on the target population than when it is done by someone else. These interventions have been used in preventing a health concern, and the results have always been successful. 

Social media campaign program can be implemented to help combat the spread of HIV/AIDS in Jacksonville. The significant stakeholders to be included in the implementation of the program include the health workers, counselors, nongovernment organizations as well as state agencies and community volunteers. The health workers have a responsibility of helping regulate the spread of HIV by creating awareness through social media platforms on the modes of transmission, risks of being infected, assisting people to change their sexual behavior and offering healthcare and counseling to the already infected individuals. Counsellors can be used to provide advice to the HIV patients directly online and guide them on how to live a healthy life without affecting others. The NGOs and state agencies can provide resources required to implement the social media campaign program successfully. 

The campaign program initiative to be implemented can form a partnership with both public and private institutions and bodies to help fight the spread of HIV with a strengthened voice. By partnering with the government, social media campaign can reach wider coverage through the use of government media channels such as state television broadcast and radio stations in addition to the social media platforms. The state can also provide resources regarding funding and training of health workers to enable them to deliver appropriate messages targeted to change the lives of the target population in the social media. Partnering with private sectors can also help in the successfulness of the plan through provision of other supporting resources. 

The timeline for implementing the program will be six months. Within six months, it is expected that the intended social media messages will have reached the intended audience. The effectiveness of the campaign can be evaluated at the end of the six months of implementation. The evaluation can be done by looking at the statistics on the number of patients who visit health centers to know their HIV status and seek medication. The target is to have at least 10% of the target population get awareness of the HIV infections and visit health facilities for testing. If there will be a change in people’s attitude towards HIV by avoiding stigma against the infected and coming up openly to speak about the disease, it will be concluded that the program is successful in its objective of helping fight against HIV infections in the city. 

The measurable tools that can be used to evaluate the program include the number of individuals who will have turned up at the health centers to know their HIV status and seek medication. The percentage decrease in the new infections within a year will also be used as a measurable tool to evaluate the effectiveness of the campaign. If there will be a decrease in the new HIV diagnosis within a year, the program will be considered successful. The cost of implementing the campaign will include the costs of hiring health experts who will be offering awareness messages to the target population. Other prices will consist of the costs of using the social media such as costs of buying data or Wi-Fi that will be used to access the internet. Online devices such as computers will also form part of the costs as the devices will be necessary for communicating with the audience online through Facebook, Twitter or even YouTube. 

Social media marketing supports the community health nurse’s efforts to ensure a healthy community by creating awareness among the target population on how to combat the HIV infections and the best ways to live healthy lives ( Luca, N. R., & Suggs, L. S. 2013). It supports nurse’s efforts by helping the audience understand the modes of transmission of HIV and the need to visit health centers for testing and treatments. This campaign can apply to my future nursing career by equipping me with more knowledge on the community health and an understanding on how to control the spread of HIV in the society. The knowledge acquired through this campaign such as guidance and counseling will be useful in the future career as a nursing student and promote my ability to handle different kinds of patients in the future. 

References 

Magill, S. S., Hellinger, W., Cohen, J., Kay, R., Bailey, C., Boland, B., & Goraczewski, L. (2012). Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida.  Infection Control & Hospital Epidemiology ,  33 (3), 283-291. 

Patel, P., Bennett, B., Sullivan, T., Parker, M. M., Heffelfinger, J. D., Sullivan, P. S., & CDC AHI Study Group. (2012). Rapid HIV screening: missed opportunities for HIV diagnosis and prevention.  Journal of Clinical Virology ,  54 (1), 42-47. 

Ackers, M. L., Greenberg, A. E., Lin, C. Y., Bartholow, B. N., Goodman, A. H., Longhi, M., & Gurwith, M. (2012). High and persistent HIV seroincidence in men who have sex with men across 47 US cities.  PloS one ,  7 (4), e34972. 

Burns, N., & Grove, S. K. (2010).  Understanding Nursing Research-eBook: Building an Evidence-Based Practice . Elsevier Health Sciences. 

Wakefield, M. A., Loken, B., & Hornik, R. C. (2010). Use of mass media campaigns to change health behaviour.  The Lancet ,  376 (9748), 1261-1271. 

Wei, C., Herrick, A., Raymond, H. F., Anglemyer, A., Gerbase, A., & Noar, S. M. (2011). Social marketing interventions to increase HIV/STI testing uptake among men who have sex with men and male‐to‐female transgender women.  The Cochrane Library . 

Luca, N. R., & Suggs, L. S. (2013). Theory and model use in social marketing health interventions.  Journal of health communication ,  18 (1), 20-40.