Introduction
This paper analyzes the Houston gay community in Texas, USA as a special group requiring health programs for HIV prevention. For purposes of this study, focus is given to the Montrose area because it bears the highest number of gay people in Houston. Montrose is located in Harrison County. However, gay people are also located in other parts of the city including Kennedy, Loving, Roberts, and Borden Counties. Montrose covers about 60,000 square miles and it has a total gay population of about 86,000 members (High Beam, 2011). Montrose is a residential neighborhood with a vast population which is made up of several people, including artists, musicians, gay people and other population groups.
Montrose has a vibrant gay culture which is supported by its liberal community characterized by diverse social practices. For example, the area has been able to accommodate residential and commercial interests in a non-conflicting manner. Several gay people were known to be attracted to the neighborhood, back in the 20th century when they were helping widows and nesters renovate their houses (High Beam, 2011). It is also known that, during 1985, Montrose was characterized by a vibrant political and social system that accommodated all types of people. This factor (among other factors) have led to the establishment that, Montrose is one of the ten greatest neighborhoods in the country (High Beam, 2011). Nonetheless, Montrose has been very accommodative of the gay community, with several gay restaurants and bars dotted across the neighborhood. In 1985, it was established that, Montrose area had a gay population of about 19% of the total population (High Beam, 2011).
However, in the same period, AIDS was highly prevalent in the region because of the surge in homosexual tendencies among the population. The AIDS prevalence in the area rose to very high levels during this period, such that, common residents feared patronizing local restaurants and clubs because they feared they would be infected with the disease (High Beam, 2011). Some funeral homes in the area also declined to handle bodies of AIDS victims because they thought they would contract the disease by handling victims’ bodies. It is also known that during this period, the prevalence of AIDS was so high that the local gay community frequented gay bars a lot because they wanted to get a reprieve from the social and mental burden of having the disease (High Beam, 2011). The AIDS scourge is at the centre of this study because this paper seeks to address AIDS as a special health concern affecting the gay community in Montrose area, with a clear aim of implementing the best solutions to the problem.
Community Profile
Montrose is deemed as the area with the highest incidence of AIDS in the wider Houston region (High Beam, 2011). In turn, Houston is perceived to be the city with the highest incidence of AIDs in the wider Texas state. Though tremendous progress has been realized in reducing the prevalence of the disease (compared to the past prevalence levels), the prevalence of AIDS in Montrose areas is a reflection of the lifestyle patterns of the Montrose gay community, a decade (or so) ago.
Though Montrose is known to be a town with interesting lifestyle patterns, the main reason advanced for the high AIDS prevalence is the high number of gay people in the area (High Beam, 2011). The gay community has therefore been known to practice risky sexual behaviors which have made the region highly prone to AIDS. For instance, the gay community is noted to practice anal-genital sex, fisting, oral-anal sex, and high levels of sexual promiscuity. These factors have increased the likelihood of gay community members to contract AIDS. These sexual habits have not only lead to high AIDS prevalence in the region, it is affirmed that, the same sexual habits have led to poor mental health, high prevalence of sexually transmitted diseases, poor physical health and ultimately, a low lifespan for the gay community members of the area. Appendix one shows these characteristics.
Health Concern
Montrose suffers from increased health concerns about the health risk brought about by gay lifestyles. The region is therefore one among many other areas such as San Francisco (Castro district) which suffer high AIDS incidences as a result of poor lifestyle choices. It is nationally proved that though the gay community represents about 2% of the national population, this population group suffers most from high AIDS prevalence (World Health organization, 2011). Current estimates project that a greater percentage of new AIDS infections are realized within the gay community. The high number of new infections among the gay community has been observed to increase steadily across the 90s into recent times. Studies done in 2006 revealed that about 53% of all new AIDS infections occurred in the gay community (World Health organization, 2011). People with a history of injection use accounted for a further 4% of all new AIDS infections in America. The American gay population has been known to account for these staggering statistics but bisexual people have also been known to contribute to the same statistics (though in a smaller proportion).
Population of Interest
The Montrose region is characterized by a dynamic gay population. This means that, the gay community is characterized by young men and women as young as 15 years old and as old as 70 years. The dynamics of the gay population is attributed to the long periods that gays have lived in Montrose area. Also, the liberal nature of the Montrose community, and its accommodation of the gay people, is seen as a contributing factor to the wide dynamics of the gay population group (High Beam, 2011). However, this study targets the young gay men and women in the Montrose community. Emphasis will be given to the gay population group with the highest rate of new infections. This population group is often perceived to be young men and women between the ages of 18-27. This population group is also known to have an active sex life and also very liberal in their sexual practices (World Health organization, 2011). This predisposes them to AIDS-related complications.
Since Montrose is characterized by both men and women constituting the gay population, this paper addresses health concerns of both genders and in equal proportions because it is deemed that both genders contribute the same numbers to the entire gay population group in the region (World Health organization, 2011). For instance it is known that, there are about 21,740 male couples and 21,172 female gay couples in Montrose area (High Beam, 2011). This population sample represents an almost 50/50 representation of gender representation in the gay community. This study will therefore target all genders in equal proportions.
In terms of socioeconomic status, the Texas gay community lives in good economic conditions, based on the fact that, this community embraces a higher level of diversity. The high socio-economic status therefore, poses lower levels of barrier to entry in the job market. Also, from the same diversity, a higher sense of cultural diversity is embraced in this community. In the same regard, many employers in the region embrace the diversity brought about by gay people.
However, for purposes of this study, the local gay community hailing from the lowest socio-economic status will be targeted because they are at a higher risk of contracting AIDS (when compared to members from a higher socio-economic status). Moreover, this study will target gay community members with a lower educational level because they are also at a higher risk of contracting AIDS (when compared to people with a higher educational level). This analysis is true because AIDS is partly subject to people’s awareness regarding its dynamics. People with higher educational levels are therefore more knowledgeable about the disease and therefore, they can protect themselves better than people with a lower educational level (American Psychological Association, 2011, p. 1).
To further explain how the population of interest is linked to health inequity in the region, gay members from a higher socio-economic status are deemed to live at a lower risk of contracting AIDS because they are less vulnerable to socio-economic factors encouraging the spread of HIV and AIDS. For instance, people hailing from a lower socio-economic status are more vulnerable to AIDS because they put their lives in danger by using sex as an economic tool to improve their lives. For instance, some women coming from lower socio-economic status are known to engage easily in risky sexual behaviors to gain economic favors (American Psychological Association, 2011, p. 3). Moreover, people from a lower-socioeconomic status are known to live poor lifestyles after contracting AIDS because they have less treatment options when compared to patients from a higher socio-economic status.
American Psychological Association (2011) notes that, people coming from a lower socio-economic status are at a higher risk of contracting AIDS because they are initiated into sex, much earlier than people from a higher socio-economic status. Furthermore, the same population group is synonymous to rare condom use, which increases their risk of contracting AIDS. From another point of view, American Psychological Association (2011) explains that:
“Unstable housing has been linked to risk for HIV infection, including IV drug use and unsafe sexual behaviors. Homeless individuals or people in unstable housing arrangements are significantly more likely to be infected with HIV, compared to individuals in more stable housing environments” (p. 12).
Collectively, these factors expose the unequal health impact of AIDS across the gay population.
Community Resources and Partners
AIDS is being fought through many partners in the Montrose community. At the centre of this fight is the corporate partner. For instance, corporate partners have organized several health walks in the community to sensitize people against the disease. These walks have also been used as strategies for providing AIDS patients with treatment facilities for the care and treatment of the disease. The community also has a website to sensitize the young people against AIDS at a young age. This online tool has been used as a sensitization tool for the local community to be aware of the effects of AIDS and how it is affecting the community (American Psychological Association, 2011). These sites are run by local groups in the community which have been designed to help in fighting the disease. Health groups have also contributed immensely to the provision of treatment facilities for AIDS victims and the running of awareness programs for the locals (High Beam, 2011). They have also carried out extensive programs in public institutions including schools, health centers (and the likes) to provide the community with prevention and treatment services for AIDS.
Diagnosis
Though it is affirmed that several partners are contributing to fight AIDS in Montrose, there seems to be a gap in the prevention and treatment programs in the community. This gap is evident from the fact that, patients seek treatment of AIDS only after they have experienced the symptoms of the disease. This means that, they rarely seek health services in early stages of the treatment, but most importantly, as a prevention measure against the disease. Health personnel are therefore left in a situation where they have to help patients when it is too late to do so. Even though some patients seek treatment as a result of AIDS-related complications, it is affirmed that, very few people come to follow-up on the treatment.
There seems to be a gap in the prevention and treatment of the disease, based on the fact that, patients do not respond as they should when treating or preventing AIDS in the community. This creates a weakness in the efficacy of the sensitization programs aimed at empowering the community. There has therefore not been much efforts made to fill this gap in providing an effective prevention and treatment program for AIDS in Montrose.
Outcomes Identification
The outcome identification for this prevention and treatment program is a complete sensitization of the public against AIDS. So far, numerous programs have been designed to sensitize the gay community about the impact of their lifestyle choices and sexual behaviors (with respect to AIDS) but there has been minimal response to the implementation of these programs. There has therefore been a gap in the implementation of the prevention and treatment programs because it is not true that the gay community does not understand the impact of their sexual behaviors; they only fail to implement what they know. The ideal situation or outcome of this program would therefore be a through implementation of prevention and treatment services for gay members in the Montrose community. An ideal outcome would also be that gay community members would undertake follow-up exercises to monitor the progress of their treatment or a continuous implementation of prevention strategies.
Planning
The planning phase of this study will be based on the framework of the Minnesota Intervention wheel. This framework defines the scope of the nursing initiatives and presents the public health initiative as a specialty practice of nursing. The following diagram explains this framework.
The planning phase will therefore be based on the physical and sexual violence experienced in the gay community. The program will be centered on educating the public about the contribution of coercion and economic factors affecting AIDS. This may include the economic factors contributing to the increase of AIDS. Such factors may therefore include the socioeconomic factors affecting AIDS. The second analogy includes the importance of upholding safe sexual practices as a preventive measure against AIDS. This phase will be aimed at changing the behavioral patterns of the people regarding the treatment and prevention of AIDS.
The contribution that nurses make to the health prevention programs is immense. For instance, the task of engaging community members to implement educative programs at institutional levels can easily be done by the nurses. Nurses can take a proactive role of initiating the implementation of preventive programs in these institutions by advocating for a community-based approach in tackling AIDS. This means engaging with public officers or administrators to seek consent or support to undertake AIDS programs in their respective public forums. For example, nurses can engage school principals and heads to allow them to carry out health programs in their institutions. Nurses can also provide a professional point of view in the design and implementation of these programs. This contribution stems from the fact that, nurses have been highly trained in designing community-based health initiatives and therefore, they can provide valuable insights during the design phase of the health programs.
The possible public and private partnerships that could be forged in the implementation of these health programs can be done through the participation of the community and relevant health bodies in the implementation of the programs (Healthpeople, 2011). This partnership is based on the fact that, for a good community-based health program to succeed; there ought to be an effective engagement of the community with the relevant bodies undertaking the initiative.
The overall objectives of implementing these activities would be to sensitize the people against AIDS, and to empower them to make proper lifestyle choices that minimize their risk of contracting AIDS. Moreover, the public health initiative will be aimed at sensitizing the public, and more so, the gay community to undertake proper treatment and prevention services against AIDS. This includes the uptake of follow-up activities and treatment methods.
The health program is designed to be implemented in three strategies. The first stage will be the design phase. This phase takes two weeks to complete. The second phase will be the implementation phase. This phase takes four weeks to complete. The last phase is the review and evaluation stage. This stage is expected to take about two weeks to complete.
To evaluate if the strategy used in the development of the health program is effective, the CDC framework will be used. This framework analyzes several concepts. First, the framework analyzes stakeholder engagement in the program implementation process (CDC, 2011). Secondly, the evaluation framework analyzes the design of the program to establish how well it meets the program objectives. Thirdly, the evaluation framework will be evaluated based on the lessons learnt from the entire health program (CDC, 2011). These lessons will be based on the objectives of the study. This means that, the more the lessons learnt, the more the objectives of the programs to be understood.
Conclusion
The nursing health programs identified in this paper have contributed immensely to the minimization of AIDS prevalence in Montrose Texas because they have increased the level of awareness among the gay community regarding the importance of undertaking a consistent prevention and treatment program to reduce the risk of contracting AIDS. This initiative was aimed at improving the awareness of AIDS among the gay community and how to improve the treatment, care and prevention of the disease among the gay community. Moreover, the findings of this study have added to the growing knowledge about AIDS, its prevalence in the gay community and the strategies that can be adopted to curb the menace in future.
References
American Psychological Association. (2011). HIV/AIDS & Socioeconomic Status. Web.
CDC. (2011). These manuals use the CDC Framework. Web.
Healthpeople. (2011). Department of Health and Human Services Launches Healthy People 2020. Web.
High Beam. (2011). The Price Of AIDS. (Montrose Neighborhood, Houston, Texas). Web.
World Health organization. (2011). World Health Organization Issues Guidelines For HIV Protection In Gay Men, Trans People. Web.
Appendix
One) Community Health Genogram
