Increasing awareness of HIV/AIDS prevention in African American females aged 15-25

Assessment

The geographic area studied is Baltimore City, Maryland, a largely urban area with approximately 621,342 people as of 2012. The population that is predominant in the area is African Americans at 60%, nearly double the average of African Americans in the state as a whole. The homeownership in the city is only about 49%, lower than the state average, which correlates to the median household income of $40,000, a full 30% lower than the Maryland as a whole. Baltimore City’s subdivision of Park Heights, according to the U.S. Census Department, has a higher rate of crime than the surrounding area because of drug and gang problems and is the area of study. This neighborhood is largely African Americans of Caribbean descent and the careers available locally are industrial or commercial in nature. The area is in the process of redevelopment to help reduce the crime in the area (Baltimore QuickFacts, 2012).

HIV/AIDS has been an issue in Park Heights, especially in the African American community. A combination of attitude, education, socioeconomic status, and cultural perspectives of condoms are part of the issue. One of the biggest goals for Healthy People 2020 is to stop an increase in new cases of HIV/AIDS while examining the effects of different variables such as; substance abuse, age, gender, and marital status. As of 2007, the baseline data for new AIDS patients was 13.8 new cases per 100,000 people aged 13 years and older and one of the major goals is to decrease this number by 10 percent (HIV-Healthy People).

As a country, the awareness of the HIV/AIDS epidemic has been increasing in the last 30 years, including prevention and treatment of the disease. Large, nationwide programs such as the National HIV/AIDS Council funded by the federal government have been working to help spread awareness on college campuses and public areas that young adults frequent in an attempt to provide one level of coverage. State programs, such as Maryland’s “Greater than AIDS,” strives to reach out to young people and increase understanding of how the disease is spread and the importance of testing after unsafe sexual acts (Neighborhood Health Profiles). 

The population of interest for HIV/AIDS intervention is young, Black, unmarried women and to encourage them to use condoms when engaging in sexual acts. The age group generally studied is 15-25 years old, a group that is increasing the fastest in new HIV/AIDS cases, according to Healthy People 2020. Young women are considered a focus group for HIV/AIDS prevention program because one goal for Healthy People 2020 is to increase condom use in sexually active unmarried females aged 15 to 44. The current statistic from the Healthy People database is that only 35.1 percent of this population used a condom at last sexual intercourse (2007).

Since education levels are often correlated with the low socioeconomic status, examining various statistics regarding the public schools in Baltimore County is also important to understand the population, especially considering that young people are sexually active at a younger age. Therefore, HIV/AIDS prevention needs to follow this trend and educate teens at a younger and younger age. In the county, the population is 45.9% eligible for free and reduced lunch, an indicator of a high poverty area (School Progress Index, 2012). One positive that was identified was that the district received recognition for having the fourth highest graduation rate for African American males among the nation’s largest school districts (About Us- BCPS.org).

This health concern is related to an inequity of access is for the accessibility of women below the age of 18, who may not be able to get to the Planned Parenthood, which is 25 miles from Park Heights. While the local Baltimore hospitals also offer access to free condoms, this is not advertised to young people who may not have health insurance or know to visit the doctor’s office for condoms. In the article “Planned Parenthood Highlights New Data and Teen Strategies” the new program called ¡Cuídate! is described as being an outreach program geared specifically at Latina women ages 13-20 that includes cultural references so that the teens can identify with the literature and posters (Press Releases- Planned Parenthood). However, this kind of outreach has not yet been developed specifically for African American teens, although it may be developed in the future. 

One major supporter in combatting new AIDS/HIV cases is the non-profit AIDS Action Baltimore (AAB) which, according to their website, “is dedicated to the support and education of people with HIV and prevention of HIV in the Baltimore area” that can provides informational resources for AIDS prevention and outreach programs and a free community forum. They also have a connection to the Maryland Department of Health and Mental Hygiene which houses the Center for Sexually Transmitted Infection Prevention (CSTIP). This is the state program provides training to state and city level organizations that educate or provide services to people at risk of unsafe behavior, or other environmental factors. One organization that CSTIP supports is the University of Maryland AIDS prevention center, where the goal is to reach out to the high school and college age students (AIDS Actions Baltimore).

Diagnosis

One aspect of the health concern not being addressed despite the efforts of the partners involved is not educating people young enough. As statistics show that teenagers are engaging in unsafe sexual acts at a younger and younger age and the organizations are mainly focusing on older teens. Middle school may be a better time to encourage safe sex because, by the time they get to adulthood, the individuals already have beliefs about HIV/AIDS prevention and have developed their attitude towards condoms (HIV-Healthy People).

Outcomes

To increase awareness of HIV in young Black women, especially high school age to focus on the prevention aspect. The goal is to place informative posters to invite young women to access information about HIV/AIDS prevention. The goal is to place 100 informative posters that provide information about physical locations of Planned Parenthood, other locations that provide free condoms and online resources geared towards young adults; the desired success of the program is an increase of 10%. The percentage will be measured by increases in both physical and virtual access to information.

Planning

In this plan, the nursing action needs to be providing awareness through the dissemination of literature and posters while working with organizations that further educate the demographic of focus. The Minnesota Prevention Wheel places this action in the “Advocacy,” and “Social Marketing,” realms where the population is informed of the safe-sex actions and also places to get free condoms.  This is a community focus activity that is designed to what the Wisconsin Department of Health Services’ Intervention Wheel calls for a “Change in community norms, attitudes, practices and behaviors” and target young Black women specifically. This means that locations of the posters must be decided based on data gathered from population density maps that show the neighborhoods with the highest density of African Americans. While young Black women may choose to eat and shop outside of their neighboring area, there is a greater chance they will frequent at least some shops in the area that is within walking distance to their homes. 

The primary prevention is to use positive propaganda to show young women that access to condoms is local, free and anonymous by informing them of the location and organizations that offer them. One goal is to break the taboo and encourage young women to think that using condoms is a normal and necessary part of sexual activity. This is especially true of the online resources because they can access it on their own time and in privacy. The secondary prevention is to offer young women a place to go if they have, or may, engage in unsafe sexual activities to get tested for the disease to stem further spread. The online resources can be important for the secondary prevention because the young women may feel the need to reach out through an anonymous message board to find out more information, where they can be encouraged to seek testing and help.

There are many organizations that seek to educate young people and appealing to non-profits to encourage them to offer programs for younger adults is a possible partnership. One of the aspects that AIDS prevention programs have not capitalized on is social media such as FaceBook and Twitter, a place where many young people go to gather information about their community. Approaching local businesses that young people frequently shop or eat at and asking permission to place literature or posters in their publicly accessible restrooms may also allow young people to take information about resources privately. Included in the literature is also a location list to show young people the nearest resource centers. 

The objective is to increase awareness of young females about HIV/AIDS prevention by at least 10% by reaching out to the females at a younger age and in places they would not ordinarily have access to the literature (public restrooms). It is also worth examining the current posters and see if they appeal to young women.

Timeline for expected outcomes:

Step 1: Gather materials from local agencies- Local and state organizations will donate the required posters for placement in Baltimore neighborhoods. Some materials (such as brochures) may need to be printed with information regarding local resources. A survey will need to be made to gather statistics on the increase in number of web visitors or physical visitors. 

Step 2: Identify the areas that have a high density of young black people in Baltimore City- Park Heights neighborhood.

Step 3: Make contact with local small businesses in the areas identified in Step 2 and explain the goal of placing the posters and literature in restrooms accessible to the public. For some larger businesses, a request may need to be made to corporate offices for approval.

Step 4: Place materials and literature in women’s public restrooms.

Step 5: Volunteer time at local resources to provide support for individuals who educate the clients. Volunteer time may be at phone bank or messaging board to offer information to callers or users who request information or have specific questions.

Step 6: Gather data of increased visits to websites on propaganda and increased visits to physical clinics for HIV/AIDS prevention.

Since the posters and literature may not increase visitors to the health center or the website immediately, a 60-day gathering, and evaluation of the data may be required to see if the goal of a 10% increase was reached. While survey results may not be conclusive, it can show the trend, even if the goal is not reached in the 60-day period. Collecting anonymous statistics (such as an anonymous survey) will allow me to decide if the targeted population has been frequenting the clinics in the area or accessing information online.

Conclusion

The biggest change in my perspective of the community’s health was to realize just how complicated a process it can be to get information out to the right demographic. Since the age group identified was very specific, it took extra time to find materials that were appropriate and appealing to the demographic. Once I had found the appropriate materials, going to businesses and asking to post in their women’s restrooms had only about a 60% rate. Most businesses said they wouldn’t mind but that their restrooms were not generally public. Although the posters may impact the employees, the attempted outreach was for a larger number. The businesses who denied placing posters and literature oftentimes said that they did not want to be responsible for the upkeep and that tagging was an issue on other materials in the restroom. Some agreed to place them when we told them that they could remove the posters if they were damaged.

While I was only able to make suggestions to the clinics and organizations that they should examine using social media to reach a younger crowd, the organizations were receptive to investigating the use of such outreach. However, the website access increased 6% in the time during the project and I was able to use the message boards to find out the kinds of concerns and issues that young people have. I was surprised at the number of posts from young women who stated that they had already had unsafe sex and wanted to know what their next step should be. This made me realize that more programs need to be put in place at a younger age because a proactive approach will always be more helpful in combatting HIV/AIDS.

On a county level, there did seem to be information available through resource listings to help guide young people to Planned Parenthood or other organizations that offer condoms.  On a national level, I realized how many resources were there to educate the public and offer support for individuals who had already been diagnosed with the disease. One lacking I noticed on a national level was the outreach was focused on older teens and there was very little for younger teens. This may be an issue of the general public believing that middle school age children are too young to learn about these problems; however, the data shows that they are at risk and the younger they are educated on HIV/AIDS prevention, the more positive their attitude towards safe sex may be. 

References

About Us. (n.d.). Baltimore county public schools. Retrieved from http://www.bcps.org/system/about_us.html

2012 School progress index: Baltimore County: 2012 Maryland report card. (n.d.). 2012 Maryland report card. Retrieved from http://www.mdreportcard.org/SpiIndex.aspx?PV=14:0:03:XXXX:2

AIDS Actions Baltimore. (n.d.). Baltimore health. Retrieved from http://www.aidsactionbaltimore.org/?page_id=7

Baltimore County QuickFacts from the US Census Bureau. (n.d.). State and county QuickFacts. Retrieved from http://quickfacts.census.gov/qfd/states/24/24005.html

HIV - Healthy People. (n.d.). Healthy People 2020 - Improving the health of Americans. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=22#552

Neighborhood Health Profiles. (n.d.). Baltimore City health department. Retrieved from http://www.baltimorehealth.org/neighborhood.html

Press Release. (n.d.). Sexual & reproductive health – sex education - Planned Parenthood. Retrieved from http://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-calls-increased-funding-federal-teen-pregnancy-prevention-initiative-bring-c-41295.htm

The Intervention Wheel. (n.d.). Wisconsin Department of Health Services. Retrieved from http://www.dhs.wisconsin.gov/phnc/InterventionWheel/

USA QuickFacts from the US Census Bureau. (n.d.). Maryland QuickFacts. Retrieved from http://quickfacts.census.gov/qfd/states/00