HIV: It's Still Out There!

HIV continues to plague Americans of all ages, races, and socioeconomic backgrounds. Groups with the largest number of new HIV infections include men who have sex with men (MSM), followed by African American heterosexual women (Centers for Disease Control and Prevention [CDC], 2012). The CDC (2012) states “young MSM are the only risk group in which new infections are increasing, due in large part to increases among young, Black MSM” (p. 3). The author identifies populations at higher risk for HIV according to route of transmission to include: gay and bisexual men; young, black MSM; heterosexuals; injection drug users; and transgender people.

African Americans and Latinos are disproportionately affected by HIV. The CDC (2012) mentions that African Americans account for almost half of new infections and people living with HIV. The authors attribute this finding due to the increased likelihood of African Americans to be challenged by lack of access to care, discrimination, stigma, homophobia, and poverty. The issues must be addressed before successful intervention can be expected.

According to the CDC, the following factors affect HIV risk and must be addressed:

• Poverty-limits access to healthcare and increases the chance that life circumstances will increase their HIV risk
• Discrimination, stigma, and homophobia-discourage individuals from seeking testing, prevention, and treatment
• Prevalence of HIV/STDs-the more people in a community with HIV/STDs, the greater the risk of infection
• Higher rates of incarceration among men-decreases the number of available partners for women, potentially increasing HIV infection
• Language barriers/immigration status-various challenges

The National HIV/AIDS Strategy (NHAS) is a comprehensive plan that does adequately address many of the barriers to HIV prevention and treatment. Goals are broad, interventions beneath goals are well defined, funding is greatly incorporated, and collaboration is recognized and addressed. The first goal, to reduce new infections, greatly describes the allocation of funds, prioritization of best practices, focus on high risk communities, and access to testing, treatment, and education (U.S. Department of Health and Human Services [HHS], 2011). The second goal, to increase access to care and better outcomes to people living with HIV, fully develops community availability, access to coverage or payment, increase in knowledgeable providers, and improvements in research (HHS, 2011). The third and final goal, to decrease disparities and health inequities, incorporates new research findings, addresses vulnerable populations, and includes technological resources such as telehealth (HHS, 2011).

Major areas of impact from the NHAS involve areas of funding, research, access to care, and education of providers. Funding for health departments has been substantial in all 50 states with increased values in 12 highly burdened areas with HIV (HHS, 2011). Substance abuse programs have received increased funding to test and counsel patients for HIV (HHS, 2011). Women’s health insurance plans cover preventative services without cost sharing while insurance companies no longer deny coverage to the HIV stricken (HHS, 2011). Education for providers has strengthened to include cultural competence and community centers are receiving increased resources to fight HIV (HHS, 2011). With the increase of collaborative efforts, many organizations are coming together to be a voice of one in driving further changes.

Reducing the viral load does seem minute in comparison to the many other National HIV/AIDS Strategy (NHAS) interventions, but it is important as it highlights the commitment of the NHAS to address all levels of prevention. The first goal of the NHAS, to prevent new HIV infections, addresses primary prevention. Primary prevention prevents health threats and promotes health (Stanhope & Lancaster, 2012). Actions for this goal are all aimed at prevention through education using best practices (U.S. Department of Health and Human Services [HHS], 2011). The second goal focuses on increasing access to care and health outcomes for those with HIV (HHS, 2011). Secondary prevention intervenes before a problem increases in severity (Stanhope & Lancaster, 2012). Clearly, the second goal aligns with secondary prevention methods. The final goal of the NHAS involves reducing HIV-related disparities (HHS, 2011). Tertiary prevention works to limit further negative effects and restore individuals to optimal levels of functioning (Stanhope & Lancaster, 2012). Tertiary prevention is vital to reduce mortality for those infected as this can impact overall prevention efforts. HHS (2011) states “efforts to reduce the community viral load may help reduce the number of new HIV infections in specific communities” (p. 11).

All levels of prevention are necessary for strategies to be effective. In terms of interventions, factors that are societal, community, and institutional are all critical for behavior change to occur (Glan, Rimer, & Viswanath, 2008). These factors provide an appropriate environment for the change and directly shape individual choices. A community that has a high viral load must have societal support, community commitment, and institutional support for successful intervention.

Populations at risk and that are affected by HIV require intervention to work through the issues of discrimination, stigma, and homophobia. Brooks et al. (2005) mentions that program targets must include service providers and the community at large to provide education regarding culture, stigma, and sexuality. This addresses knowledge limitations both inside and outside of organizations, crossing many roles that touch the HIV health problem. Social marketing campaigns can also work to transform norms stigmatizing HIV, furthering the successes of prevention services (Brooks et al., 2005).

The NHAS has begun to address other barriers to the strategy relating to coordination, health care coverage, and standardization of indicators. To start, indicators must be standardized and streamlined, reducing the reporting burden (HHS, 2011). Once entities can foresee common methods of monitoring and reporting, coordination efforts can develop. According to NHAS (n.d.) planning and program implementation activities are often conducted in a manner that separates prevention and care. Establishing a lead entity will assist with coordination, development, and implementation. Outside agencies and stakeholders will be identified and engaged to assist in coordination efforts (“NHAS”, n.d.). Others must join in achieving the NHAS’s goals to provide support with food, housing, and stigma.

Brooks, R. A., Etzel, M. A., Hinojos, E., Henry, C. L., Perez, M. (2005). Preventing HIV among Latino and African American gay and bisexual men in a context of HIV-related stigma, discrimination, and homphobia: Perspectives of providers. AIDS Patient Care and STDs, 19 (11), 737-744. Retrieved from http://benedictine.learntoday.info/AngelUploads/Content/MPH-601-D3A3/_assoc/site/Media/preventing.pdf

Centers for Disease Control and Prevention. (2012). Today’s HIV epidemic. Retrieved from http://www.cdc.gov/nchhstp/newsroom/docs/HIVFactSheets/TodaysEpidemic-508.pdf

Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: Theory, research, and practice. San Francisco, CA: Jossey-Bass.

National HIV/AIDS Strategy. (n.d.). Federal implementation plan. Retrieved from http://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-federal-implementation-plan-fact-sheet.pdf

Stanhope, M. & Lancaster, J. (2012). Public health nursing population-centered health care in the community. (8^th ed.). Maryland Heights, MO: Elsevier.

U.S. Department of Health and Human Services. (2011). National HIV/AIDS strategy implementations progress report 2011. Retreived from http://www.aids.gov/pdf/2011-nhas-progress-report.pdf