Background of the Study
The problem of HIV and AIDS has become a global one in the short time since the identification of the virus. Although there is no vaccine to protect against the virus, knowledge and education are two powerful shields against infection—and it has become clear in recent years that impoverished women in the developing world are particularly heavily impacted by HIV transmission and development of AIDS (UNAIDS, 2016). The goal of finding a way to slow or completely halt the spread of HIV and the development of AIDS has been an epidemiological conundrum for many years.
Promoting health and wellness education has the potential to seriously affect the spread of the disease in the developing world (Beck et al., 2012; Hlaing & Darrow, 2006). Haitian women present a particular set of epidemiological circumstances for the researcher, and the study of this particular population presents a chance for a more tailored population-based solution (Fettig, Swaminathan, Murrill, & Kaplan, 2014; Spicer & Ford, 2013; Tiruneh, Wasie, & Gonzalez, 2015).
Problem Statement
Haitian women represent a population that is particularly vulnerable to the transmission of sexually transmitted infections, including the transmission of HIV. To understand the nature of this population’s vulnerability, investigation into the health beliefs of Haitian women is necessary. The current epidemiological understanding of the spread of HIV provide some global understandings of the disease, but these global truths and trends do not necessarily take into account the culturally-specific beliefs and educational status of women in Haiti. As such, the development of a culturally-specific set of trends is essential to the development of recommendations for this vulnerable population, and for the potential design and implementation of solutions within Haitian culture.
Purpose of the Study
The purpose of this study is to utilize a post-positivist paradigm in an effort to better understand the sexual practices of Haitian women that put them at particular risk for HIV or the development of AIDS. Using the Health Belief Model of study and the Purnell model of cultural competence, the researcher hopes to investigate the overall intersectionality between the sexual practices and beliefs of Haitian women and the incidence of HIV infection within the country.
The research will investigate the perceived risks, perceived susceptibility, and cues to actions to better understand the current relationships between education, beliefs, and practices within this vulnerable population. Women in the developing world are a particularly high-risk and vulnerable population, and developing thorough, culturally-specific understandings of the nature of the problem is essential to developing long-term recommendations and solutions.
Definitions of Key Terms
Health Belief Model (HBM): The Health Belief Model (HBM) is a psychological model of thought that investigates the relationship between an individual or group’s attitude or belief towards health risks in the context of the containment or abatement of disease, infection, or behaviors (Hayden, 2013). The HBM considers the individual or group’s attitude towards risk, disease, and severity of symptomology in an effort to better understand behavior (Hayden, 2013).
Purnell Model of Cultural Competence: The Purnell model of cultural competence considers a number of cultural domains to explore issues associated with culture and cultural expression. In this context, the Cultural Competence model will be used to discuss attitudes towards sexual intimacy, sexual equality, and sexual education (Hayden, 2013).
HIV/AIDS: HIV is a retrovirus, also known as “human immunodeficiency virus.” AIDS, or autoimmune deficiency syndrome, is the resulting syndrome that is developed as a result of long-term infection with human immunodeficiency virus (UNAIDS, 2016).
Vulnerable Population(s): vulnerable populations are groups of people that are particularly at risk for the development of a certain disease or for falling victim to a certain set of problems. Vulnerable populations often include the very young or very old, but they can also include those lacking resources or education (Fettig et al., 2014).
Post-positivist paradigm: the post-positivist paradigm suggests that while the researcher and the researched population should remain independent, there are many ways in which they cannot. Objectivity and the elimination of bias are the essential goals of this paradigm.
Research Questions and Hypotheses
The research questions that will be investigated are as follows:
What sexual practices put Haitian women at risk for the transmission of HIV?
Using the HBM, what are the perceived risks, perceived susceptibilities, and cues to action associated with HIV transmission for Haitian women?
Does education play a potential role in the prevention or slow of the epidemiological spread of HIV for Haitian women?
Hypotheses
The hypotheses associated with the fundamental research questions of this project are as follows:
Haitian women demonstrate a lowered perceived risk and perceived susceptibility than real risk and susceptibility associated with HIV transmission potential.
Education plays an essential role in raising perceived risk and susceptibility closer to the real rates of risk and susceptibility.
Cues to action in regards to HIV prevention and even care once infected are not sensitive; Haitian women often fail to seek medical attention after infection, and have more advanced cases of infection before treatment than women outside of economically vulnerable populations.
Economic and educational vulnerability are linked to lower rates of medical treatment in vulnerable Haitian populations.
Theoretical Framework
The HBM suggests that there are certain beliefs are linked closely to behaviors in a target population. This particular piece of research is focused on applying concepts of perceived risks, perceived susceptibility, and cues to action in the context of Haitian women’s understandings of HIV transmission and prevention. The perceived susceptibility of a vulnerable population is how that population feels about getting a particular condition—in this case, how the population feels about the transmission of HIV (Hayden, 2013). In the case of Haitian women, the context of HIV transmission and the susceptibility of HIV transmission will be the primary area of discussion.
Perceived risk will also be discussed, and the way Haitian women perceive risk—compared to actual risk—will be discussed in the context of the HBM (Hayden, 2013). Finally, the strategies that are used to activate readiness and awareness of the issues associated with HIV transmission in Haitian culture will be discussed in the context of the HBM. The research will use the Purnell model of cultural competencies to examine the experiences and beliefs of Haitian women; special care will be taken to examine these beliefs in the context of Haitian culture rather than in the context of the home culture of the researcher.
Significance of the Study
This study has the potential to be highly instructive to the researcher interested in developing an understanding the intersection of sexual behavior, education, and HIV transmission in Caribbean cultures. Although the current literature provides excellent information regarding the general methods of preventing the spread of HIV and AIDS in developing nations around the world, there are specific and unique features of Caribbean cultures and, more specifically, Haitian culture. Moving forward, culturally-specific understandings of the health belief trends in different cultures can help structure and develop recommendations associated with the prevention of the spread of HIV and the prevention of the development of AIDS. Haiti, as an island culture, has a number of a unique cultural beliefs. The results might also be generalized to other sexually transmitted infections as well as other health-related behaviors and risks.
Significance to Nursing
The role of the nurse in the medical field is complex and evolves as the scope of practice that nurses are capable of expands. However, despite the expanding scope of practice, nurses offer a very different service in the medical field from physicians and doctors: nursing, as a practice, is patient-oriented and focused on a larger scope of wellness and care. The purpose of this section is to discuss the implications of the study for nursing education, practice, research, and health and public policy.
Implications for Nursing Education
Although not all nurses will have the opportunity to work with vulnerable Haitian populations, there is the potential for this study to provide insight regarding the behavior and perceptions of Caribbean women to sexual health and sexually transmitted infections. Although not all the recommendations and overarching understandings can be generalized, there are certainly cultural traditions, practices, and beliefs that could potentially be extrapolated by nursing professionals from the recommendations gleaned in this particular discussion. Nursing students can utilize this particular case study to understand the intricacies associated with cultural understandings of disease and the implications of education—or the lack of education—on epidemiology and viral spread.
Implications for Practice
This project will provide the practitioner with the cultural context needed to make educational recommendations to individuals from vulnerable Caribbean populations. This includes Haitian women and women of Haitian descent, as well as women of other similar backgrounds. It will also provide potential recommendations associated with the development of policy and of educational opportunity for women of these backgrounds. Nurses practicing within Caribbean communities will need cultural context through which to slow the spread of HIV and AIDS, and this project will provide context for these nursing practitioners.
Implications for Health and Public Policy
Ideally, this research will provide context for slowing the overall spread of HIV within vulnerable Haitian populations, and will potentially provide data that will be extrapolated to similar Caribbean populations. This is not to say that the research will equate other Caribbean populations with the Haitian populations, but populations with similar cultural realities have the potential to respond similarly to similar circumstances and stimuli. The goal for this project is to suggest health and public policy solutions that will slow the spread of HIV and potentially other sexually transmitted infections. Developing public policy solutions to end the HIV epidemic is not necessarily the end goals of the project; making small-scale changes that have a significant impact is the more important end goal.
Implications for Research
The research potential for the subject of HIV and AIDS prevention is great, and the potential for research into vulnerable populations like underserved Haitian women is particularly important. These populations are often the victims of the AIDS epidemic because of their extreme vulnerability, lack of access to education and prophylactics, and lack of access to healthcare (UNAIDS, 2016). Research into the potential impacts of education and the ways that education can change outcomes for large parts of the population is another potential area of study in the future. Unfortunately, large-scale population study is beyond the scope of this investigation, but the project could set the stage for future large-scale studies.
Scope and Limitations of the Study
The scope of the study in this particular case focuses on the experience of Haitian women, particularly Haitian women who are considered to be members of the underprivileged, vulnerable portions of the population. Affluent women are less likely to be infected by HIV or experience the ravages of AIDS, and women who are affluent and infected are also more likely to receive effective treatment of the disease (UNAIDS, 2016).
Limitations
Because this study is largely observational in nature, there are significant limitations associated with the development of the research. First and foremost, there are no experimental circumstances developed in this particular piece; it is merely an observational study of the current data. No experimental procedures are applied to an experimental population. In addition, the researchers are limited to the data set made available by various government and non-governmental sources; the validity of these sources might be called into question, which affects the limits of the study, as well as the external and internal validity of the study.
Threats to External and Internal Validity
The research contains potential threats to internal and external validity, although the researcher has attempted throughout the research design process to minimize potential impacts associated with invalidity. Minimization of internal and external invalidity include the development of diverse sources of data and the verification and re-verification of sources. The most important potential limitations have been discussed in the following section.
External Validity
There are a number of potential threats to external validity, but the most important threat is the lack of generalizability based on the current population. The researcher has developed a literature review based on the most applicable, current research, but there are still problems with a lack of general availability of research specifically targeted at the population of Haitian women. Because the researcher has chosen to use two post-positivist constructs—that is, the Purnell model of cultural competence and the HBM—there are potential real-world compounding effects that could be linked to the failure of recommendations set forth by the researcher. In addition, there will be selection biases that will likely be associated with the selection of literature; although the quantitative method with correlation will eliminate the problems associated with qualitative bias, the research will contain only a selection of data points.
Internal Validity
Threats to internal validity of the study include selection of data points for study, particularly as the quantitative method requires the use of a specific set of epidemiological and demographic data points. Instrumentation is a concern for this study, as much of the data cannot necessarily be verified using traditional means of verification; governmental data must be trusted as-is, and there is always the potential for mistakes in reporting and in data collection, particularly in developing nations like Haiti.
References
Beck, D. W., LaLota, M., Metsch, L. R., Cardenas, G. A., Forrest, D. W., Lieb, S., & Liberti, T. M. (2012). HIV prevention and transmission myths among heterosexually active adults in low-income areas of South Florida. AIDS and Behavior, 16(3), 751-760.
Fettig, J., Swaminathan, M., Murrill, C. S., & Kaplan, J. E. (2014). Global epidemiology of HIV. Infectious disease clinics of North America, 28(3), 323-337.
Hayden, J. A. (2013). Introduction to health behavior theory. Jones & Bartlett Publishers.
Hlaing, W. M., & Darrow, W. W. (2006). HIV risk reduction among young minority adults in Broward County. Journal of health care for the poor and underserved, 17(2), 159-173.
Spicer, C. M., & Ford, M. A. (Eds.). (2013). Monitoring HIV Care in the United States: A Strategy for Generating National Estimates of HIV Care and Coverage. National Academies Press.
Thomas, T. L., Yarandi, H. N., Dalmida, S. G., Frados, A., & Klienert, K. (2015). Cross-cultural differences and sexual risk behavior of emerging adults. Journal of Transcultural Nursing, 26(1), 64-72.
Tiruneh, K., Wasie, B., & Gonzalez, H. (2015). Sexual behavior and vulnerability to HIV infection among seasonal migrant laborers in Metema district, northwest Ethiopia: a cross-sectional study. BMC public health, 15(1), 122.
UNAIDS (2016). Global Fact Sheet. 2030: Ending the AIDS Epidemic. Communications and Global Advocacy.
