Overview
According to Grady Health System physicians and officials, HIV crisis continues to grow in the metro Atlanta area regarding young black men and women who live in poverty (Miller, 2015). There has been a spike in HIV diagnoses annually from 100 to 150 cases every year. Although African Americans only represent 29% of the Georgia population, they represented 64% of AIDS cases in 2002 (Wordpress.com, 2013). Georgia is one of the leading states with HIV diagnoses and was number five among United States metro areas. The funding for HIV/AIDS programs in Atlanta Georgia is in jeopardy of being cut which would tremendously affect AIDS research and healthcare access for the black community in Atlanta. A 2015 internal audit report conducted for Fulton County, a suburb of Atlanta, cited poor management after the county mismanaged millions of CDC grant dollars meant for HIV program use (Pratt, 2015).
Problem Statement and Background
There have been documented issues with health care facilities in the Atlanta area not following CDC guidelines for providing HIV screenings and test. Individuals who do not have access to HIV testing will continue to lack knowledge of their status and miss the opportunities to get early medical care and prevent transmission to others. Black gay men are at high risk of contracting HIV than other groups. According to the study which was conducted by Emory University sex between men aged 18 to 39 was rampart in Atlanta. The study revealed that12.1 % of those men who had sex during 24 months were found to have contracted HIV and were aged 25 years and they were blacks. The case was different form the white, since only 1.0 % of the white aged 25 were infected with the virus during the same period (Pratt, 2015). The study revealed that these were the highest figures of HIV incidence ever recorded in a well off country such as the U.S. In Georgia, AIDS was ranked as the leading killer disease among black people ages 35-44. The high unemployment rates, poverty, lack of healthcare in the Black community are the leading barriers to HIV prevention. With the funding being cut for HIV services and the expansion of Medicaid, getting coverage will be too much for people’s incomes. Most of all, the lack of knowledge of HIV is to blame for high numbers with a percentage of Georgians thinking HIV can be transmitted by sharing drinking glass.
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Approaches used to address the problem Improvement Plan
Some of the past approaches used to address the HIV/AIDS epidemic in Atlanta Georgia included: HIV Prevention Program within the Georgia Department of Public Health, the department coordinates with the Statewide HIV Prevention Planning Group, community partners, and public health districts to conduct HIV testing, data reporting, and provide capacity building and training. Currently, the HIV Prevention Program is still in place with the Center for Disease Control (CDC) funding the Comprehensive HIV Prevention Program and the Care and Prevention in the United States (CAPUS) Demonstration Project. However, CAPUS is a CDC based project aimed at creating an effective and more efficient system which will improve the HIV testing procedures and also increase the campaign awareness on how people can control the spread of the deadly virus in highest risk areas (georgia.gov, 2016). In addition to that, there is the Ryan White HIV/AIDS program; this is another government funded program that provides HIV health care services and medical care for the people lack sufficient health care coverage for HIV care.
Important socio-ecological changes that must occur to optimize the odds of program success
There are many socio-ecological factors that needs to take place for the success of the program and they include, discounting stigmas and false information, educating the community about HIV/AIDS, educating infected inmates and providing help when released, reduction of high risk drug use, and increasing access to HIV/AIDS medical care and programs.
Proposed solution and approach to target the problem
Following the CDC HIV Prevention Intervention approaches will help to target the problem of HIV/AIDS by addressing the social, community, financial, and structural factors that place specific groups at risk of contracting the virus. Among these factors includes HIV testing and linkage to care, antiretroviral therapy, access to condoms and sterile syringes, prevention programs for people living with HIV and their partners, and programs for high-risk people. Also, following the Fulton County Task Force on HIV/AIDS will focus on eliminating stigma and discrimination associated with HIV, eliminate health system barriers that make it difficult to get care, provide free and routine testing, and close the current gap that denies too many private insurance or Medicaid, and advocate for adequate federal funding for care and prevention.
Target Population Contact
The direct contact for HIV-positive and high-risk people in the Atlanta area would consist of community organizers such as church and school, community stakeholders, local health departments, and Human Services, together with Centers for Disease and Control.
Community Support
Community support can be gained and maintained by the local health departments and CDC creating a partnership with local churches, schools, media, and neighborhood residents active in support efforts of HIV prevention. This collaboration can help to generate messages through local TV, radio, newspaper, word of mouth, and local advertisement in order to gain the communities interest and provide them current information. Community support can also be obtained by recruiting people from the community to actively participate in HIV prevention projects and programs.
Reasons for possible Program Failure
Funding: Insufficient or lack of funding in most cases jeopardizes health insurance coverage for people living with HIV. In addition, it diminishes the ability of the state and the federal government to target cities like Atlanta with the highest burdens.
Community involvement: The lack of community involvement reduces HIV/AIDS awareness and involvement.
Education programs: The lack of education programs increases stigma which is the number one cause of reluctance in people to get tested and seek medical treatment and care for HIV/AIDS.
Signs of Program Success
Some of the initial subsequent signs that will show the success of the program can be observed when the rate of H IV/AIDS testing throughout the Atlanta area increases, and when the rate of HIV/AIDS in black men and women reduces.
The Precede/Proceed Model Hiv/Aids Metro-Atlanta
Phase 1 - Social Assessment
The purpose of phase one is to identify the social problems and the impact of the quality of life for individuals living with HIV/AIDS in the Atlanta area and understand the social problems with HIV/AIDS in the black community in Atlanta. Metro-Atlanta Georgia has been experiencing an HIV/AIDS crisis among the African American population living in poverty. The first step to reducing the HIV/AIDS rate in Atlanta is to meet with key groups on a monthly basis to address issues and common concerns. The following are methods used and results:
Methodology
The methods used included, community forums, focus groups, surveys, questioners, clinical or hospital surveillance data and identifying and meeting community stakeholders.
Results
These are some of the outcomes: a high number of HIV/AIDS diagnoses among black male of between the ages of 18 and 39, the existence of a rate of unemployment of black people in the Atlanta-metro area, increased poverty in the black Atlanta area, lack of healthcare in the black community and lack of insurance coverage in the black community.
Phase 2 - Epidemiological Assessment
An epidemiological assessment has determined that the highest districts of Georgia to include Fulton and DeKalb was named as one of the region with the highest numbers of persons living with HIV infection with two-thirds (66%) of people with HIV living in Metro-Atlanta in 2014 (Georgia Department of Public Health, 2014). There has been a spike in HIV diagnoses annually from 100 to 150 cases every year. Although African Americans only represent 29% of the Georgia population, they represent 69 percent of AIDS cases in 2002 compared to 6% Hispanic and 20% white (Aidsvu.org, 2016). HIV disproportionately affects the black community in metro-Georgia with black males being 5.6 times that of white males to infect and 12.6 for black females compared to white females Georgia is one of the leading states for HIV diagnoses and number five among United States metro areas. The environmental risk factors for HIV/AIDS include lack of access to medical care, poverty, lack of education/information, unprotected sex, and incarceration among men and clustering effect of gay men. The behavioral risk factors include risky behavior and stigmas and beliefs. Below are the sub-objectives for planning for a 12 month period:
• Environment Sub-objective 1: Increase access to medical care by 50%.
• Environment Sub-objective 2: Increase funding for the uninsured 25%.
• Environment Sub-objective 3: Increased funding for HIV education and information by %25.
• Environment Sub-objective 4: Increased funding for HIV support programs for ex-prisoners by 13%.
• Environment Sub-objective 5: Increase funding for HIV education, testing, and program support for gay men by 25%.
• Behavioral Sub-objective 1: Increase funding for HIV education, program awareness, and contraceptives by 25% to local and community groups.
Phase 3 – Educational and Ecological Assessments
HIV education can be helped or hindered by predisposing factors such as knowledge, attitudes, beliefs, and values. Below are pre-analysis for each behavioral sub-objective in order to identify all factors that are relevant, predisposing, reinforcing, and enabling:
Behavioral Sub-objective 1: Increase funding for HIV education, program awareness, and contraceptives by 25%. The identified predisposing factors are belief that risky behavior such as unprotected sex shows that nothing wrong with a person whereas the sub-objective is that people living in Metro Atlanta will understand the importance of using contraceptives. Another factor is the belief that behaviors show how much you love someone and its sub-objective is that People living in Metro Atlanta will understand the importance of communication regarding HIV and safe sex.
Another belief is that only gay people get HIV/AIDS and its sub-objective is that people living in Metro Atlanta will be educated on the myths and facts about HIV/AIDS.
Phase 4 - Administrative and Policy Diagnosis
Although there is speculation that funding my potentially be cut for HIV/AIDS programs in Atlanta Georgia, President Obama’s fiscal year 2017 federal budget request was estimated to be $34 billion for combined domestic and global HIV efforts (KFF.org, 2016). HIV programs to include the CDC funded Comprehensive HIV Prevention Programs for Health Departments which helped to reduce the spread of HIB among Georgians by identifying new HIV cases and previously diagnosed cases. Another HIV program called the Ryan White HIV/AIDS program provides primary medical care and support services for HIV diagnosed people who are uninsured or underinsured. Programs such as these can help to provide HIV/AIDS education, care, and treatment needed for the targeted population of the Metro-Atlanta area. The Federal government funds several HIV prevention programs to include the National Prevention Information Network (NPIN), CDC prevention programs, National Institute of Drug Abuse (NIH), and International Mother and Child HIV Prevention Initiative (USAID). All seek to offer prevention initiative resources funded by the government and non-government agencies. Federal HIV/AIDS education program are majority government funded program from the CDC that focuses on controlling the epidemic by working closely with the locals, state, national, and international partner regarding the surveillance, prevention, and research activities.
The State of Georgia currently has HIV testing laws to protect the public by conducting an examination of infected of suspected persons and report for treatment to a physician. The government works with locals organizations to provide and support HIV testing programs. Law of disclosure of AIDS is established to protect the spouses or sexual partners that are infected with HIV by the physician disclosing the information through notification. Also, HIV infected persons are required by law talk about their health status with their partners especially when engaging in sexual activity or other activities that are likely to spread the virus.
Phase 5 - Implementation of the Program
The first step to the implementation process of HIV/AIDS program is to provide preventive interventions to prevent further spread of the virus and to ensure that people who are diagnosed get the proper medical care needed throughout Metro Atlanta. CDC prevention programs can provide valuable information regarding reduced risk practices to the targeted population through community planning groups, state, local health departments, and community organizations. The Ryan White HIV/AIDS program can be utilized to provide HIV health services and medical care for the people who are not covered for HIV care. The local community organizations can work with the Care and Prevention in the United States (CAPUS) Demonstration Project in providing additional HIV testing programs to identify infected people and get them into care and counseling support. The National Institute of Health (NIH) can provide more HIV/AIDS research along with the CDC providing surveillance and reporting to increase investigation of HIV causes, treatments, and cures.
Phase 6 - Process Evaluation
The process evaluation should be conducted during the implementation of the HIV/AIDS prevention/support program to ensure that the implementation of the programs is going as planned.
Phase 7 - Impact Evaluation
An impact evaluation is phase seven it is done to evaluate the changes in pre-disposing, reinforcing, and enabling factors as well as environmental and behavioral factors. Community groups and stakeholders will coordinate with local health departments; government agencies in order determine HIV/AIDS program performance and impact on prevention and care. A quarterly performance/impact report will be used to measure will be used to measure the effectiveness of the programs and the targeted objectives: increase access to medical care by 50%, to increase the funding for the uninsured to 25%, to increase funding for HIV education and information by 25%, to increase funding for HIV support programs for ex-prisoners by 13% to increase funding for education, testing, and program support for gay men by 25%, and to increase funding for HIV education , program awareness, and contraceptives by 25% support for gay men by 25%, and to funding for HIV education , program awareness, and contraceptives by 25% to local and community groups.
Phase 8 - OUTCOME EVALUATION
The outcome objective of reducing HIV/AIDS rates and increasing HIV/AIDS program and access to medical care within the Metro Atlanta area will be measured over a 12 month period to access if the changes will result in a 15% reduction in HIV/AIDS cases among Blacks in the area.
HIV Questionnaire
The tool that I chose to use is a questionnaire in order to assess if a person is at high risk for HIV. The reason for using a questionnaire is to conduct an assessment of high-risk individuals in order to prevent new infections of HIV which is an important and critical in stopping the epidemic in Metro-Atlanta. This type of high-risk assessment questionnaire can be used as an information guide for an individual patient to help determine that person’s risk for HIV in order to properly individualize risk reduction counseling and better support positive behavior change. The first step is to start by ensuring confidentiality and explaining to the participant why the questions are important. For example, the staff that is conducting the questionnaire can starts off by saying the questionnaire is strictly confidential and that there will be some personal questions asked. The staff will allow the participant to ask any questions before the assessment begins. The second step would be to start with the profile questions. This would include:
1. What is your age?
2. What is your race?
3. Are you married or single?
The next step is to move gradually to the core questions that are quite sensitive in nature. This type of questions includes:
4. Have you or your sexual partner(s) had other sexual partners in the past year?
5. Have you ever had an STD?
6. Have you or your sexual partner ever injected drugs or shared needles?
7. Are you a male who only have sex with women?
8. Are you a male who only have sex with men?
9. Are you a male who have sex with both men and women?
10. Are you a woman who only has sex with men?
11. Are you a woman who only has sex with women?
12. Are you a woman who have sex with both men and women?
13. Have you had unprotect sex in the past year?
14. Are you or someone you’re having sex with ever been incarcerated?
15. Have you ever had sex with an HIV infected person?
16. Have you ever had sex with a prostitute or someone who sells their body?
17. Are you pregnant with multiple sex partners or past multiple sex partners?
18. Have you had a blood transfusion before the age of 18?
19. Have you been a victim of rape or any sexual abuse? (Skidmore.edu, 2016)
The answering of yes to any of the core questions would indicate that you should consider having an HIV test as soon as possible and continuing every year. This high-risk assessment would be used to help the individual by following up with HIV risk reduction counseling in order to reduce the risk. For example, counseling would go over the following: how to decrease substance abuse by accessing substance use treatment and not injecting or sharing needles; how to decrease sexual risks by abstaining from sexual activity, being monogamous or using condoms; how getting tested and treated for an STD can reduce your risk of becoming HIV positive; and how getting tested and knowing your partner’s status will prevent the spread of HIV.
Conclusion
HIV/AIDS has continued to claim lives yet it is a health condition that can be managed and the victims of it can still live longer. In order to help in combating this menace, I intend to work with HIV institutes and individuals who have close to, or similar goals that would help in curbing the rising rate of HIV infection amongst community member of Metro-Atlanta. In so doing our area of focus will majorly be in providing proper extensive knowledge on HIV to the community members which is vital to informing individuals of the ways of contracting HIV, preventive measures and managing it. This will therefore in reduction of the wrong beliefs and myths about HIV that in many ways contribute to the increase of infection rate and stigmatization of the victims. In addition, I will enlightening and empower people through community forums, seminars and training so as to encourage them to know their status through screening and testing, which is the number one step in avoiding infection or protecting oneself and others from contracting HIV. Provision of contraceptives to the community and ex-prisoners is another step in reducing the rate of HIV infection amongst people. Hence the need of proper use of funding and provision of materials like antiretroviral drugs, contraceptives and energy boosters needed by HIV/AIDS persons.
Apart from encouraging people to stop stigma, it is very important for HIV victims to accept their status since it’s the best way to start managing the condition, therefore in such cases, I’ll be doing follow ups at least monthly, to make sure that they are doing well and practicing the given knowledge like taking their medication in the right way and time. Family support is also very important, and the education and knowledge I’ll be passing out will come in handy so as the family members of HIV victims may know how best they can take care of their loved one without infecting themselves or deteriorating the condition of the infected person.
HIV/AIDS is manageable and it is every one’s responsibility to make sure that they are protected and so are their sexual partners.
References
Aidsvu.org,. (2016). Georgia Highlights Retrieved from: http://aidsvu.org/state/georgia/
Georgia Department of Public Health,, (2014). HIV/AIDS epidemiology section HIV surveillance summary Retrieved from: https://dph.georgia.gov/data-fact-sheet-summaries
Georgia.gov,. (2016). HIV prevention program Retrieved from: https://dph.georgia.gov/hiv-prevention-program
KFF.org,. (2016). US federal funding for hiv/aids : trends over time. Retrieved from: http://kff.org/global-health-policy/fact-sheet/u-s-federal-funding-for-hivaids-trends-over-time/
Miller A., (2015). On world aids day, a grim reality in Atlanta Retrieved from: http://www.georgiahealthnews.com/2015/11/world-aids-day-grim-reality-atlanta/
Pratt, T, (2015). Atlanta’s alarming hiv/aids epidemic reminiscent of New York in the 80s Retrieved from http://america.aljazeera.com/articles/2015/12/30/Atlanta-alarming-rates-HIV-AIDS.html
Skidmore.edu.. (2016). HIV risk assessment questionnaire . Retrieved from: http://www.skidmore.edu/health/education/sexual/hiv-questionnaire.php
Wordpress,. (2013). Georgia minority health and health disparities report Retrieved from: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/georgia-s-minority-health-and-health-disparities-report-facing-a-crisis.pdf
