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
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
The increased awareness education would be measured using data
pertaining to changes in the number of individuals who seek screening
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.
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”
Dyer, J. G. (2003). The black cloud over the Sunshine State: Health
disparities in South Florida. Journal of Cultural Diversity, 10(20),
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
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,
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
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
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HEALTH PROMOTION PROPOSAL I PAGE * MERGEFORMAT 8
HEALTH PROMOTION PROPOSAL I 1
Health Promotion Proposal I
Roberto E. Gimenez
Roberto E. Gimenez