Abstract
This is an article about HIV in the state of Missouri. The article focuses on the challenges of the current status of HIV infection in the African American community. Focusing in St. Louis, this essay examines the cultural, social, and political challenges that affect both the providers of healthcare and the patients. A snapshot as the main problem is the obvious devoid in educational training among the healthcare providers on the dangers of HIV and the cultural stigma associated with the disease. The article concludes with an array of recommendations that would be applicable in finding solutions for the problem of HIV pandemic in the state of Missouri, particularly the city of St. Louis
Introduction
It is important for one to understand that HIV infections usually occur on the platform of historical social and cultural challenges in the affected communities. Perhaps some of the most documented challenges arising from HIV include the little elements and forces of racism, sexism, homophobia as well as challenges accruing from fear and stigma. While the said forces may go unnoticed, they play a significant role, fueling the high transmission rates as well as the responses from the responsible government organs (Estrada, 2002). The interconnectedness of the said forces affects the aspects of HIV/AIDS in the African- American community in the St. Louis area. Some of the most affected areas include prevention, access to healthcare, mental health support, treatment, participation in clinical research as well as others. Also hidden in the issues are areas of risk behavior, cultural norms on sexuality, and other behaviors that include gender roles and the expectations on women. This is a paper about HIV and the social effects that surrounds the implantation of effective health care.
In Missouri, HIV and AIDS diagnoses tremendously alter the lives of the women and men that are affected. The Diagnosis of HIV and AIDS present critical challenge of the living, threatening the fabric of the society as well the opportunity for a healthy life and a stable family. Some of the most commonly used HIV treatment methods include the emphasis on behavior change, improving resources that help others to improve, and making life choices that promote healthy and meaningful lives. In addition, to the change in life and cultural aspects of life, it is appropriate those new patients of HIV to attend therapy to avoid depression, as well as other side effects that may arise from the diagnosis.
According to the National Center for HIV/AIDS (2010), African Americans are the most affected with HIV in the United States (US). As of 2007, African Americans accounted for approximately (46%) of people living with HIV in the 37 states and 5 U.S territories. The 2006 reports indicated that African Americans accounted for (45%) of new infections in 50 states and the District of Columbia. Even though the acquisition rates of HIV have gone down overtime, infections rates among African Americans have been roughly stable since the 1990s. Compared with members of other races and ethnicities, African Americans still account for a higher percentage of HIV cases and deaths in the United States.
In Missouri, HIV has been a thorn in the flesh for the community. St. Louis, the biggest metropolis in the state has one of the highest rates of HIV cases in the United States. KMOV, St. Louis leading Health Newspaper reported that more than five thousand people in the greater St. Louis area live with HIV with African Americans being the most affected social group. In 2010, 300 new cases of HIV sufficed. According to the State Health Department, over 75 percent of the cases affected African Americans. African American women were most hurt with 86 percent of the new cases victims being women (KMOV, 2011). This paper explores the problem of HIV in Missouri with emphasis on how HIV affects African Americans. The last section of the paper suggests solution that offers solutions for the problem of HIV.
Literature Review
According to Medicine Net, an online-based medical consultant, HIV is a virus that enters a group of specific immune system’s cells and kills them. With time, it makes the body to incapable of defending itself adequately from opportunistic infections. After about five years, the body stops manufacturing white cells. The white cells facilitate the body defense mechanism against diseases. With low white cell count, opportunistic infections certainly affect the body thereby affecting the body’s immune system. After a long period of incubation that can sometimes extend to ten years, the HIV causes AIDS. AIDS has no known symptoms because it works with opportunistic infections. The clinical manifestation of AIDS is a collection of opportunistic diseases. While some of the AIDS manifestations are severe such as TB, others are less severe and comparatively harmless like a common cold. There is no known cure of HIV although continued medical research has reduced the deaths caused by HIV (Medicine Net Inc, 2012).
Transmission of HIV
Lyon & D'Angelo (2006), documents some of the most common causes of HIV. According to the most, the common ways that people acquire HIV include blood transfusion, prenatal acquisition, and sexual ways. According to Lyon & D'Angelo, when AIDS cases were first reported in 1980, many young adults, and children acquired the virus through unchecked blood transfusion to heal conditions such as hemophilia, in which clotting blood required replenishing. However, since the discovery of the causes of HIV, the cases from blood transfusion have significantly declined (p.4).
Royce, Sena, Cates,& Cohen (1997) reported that transmission of HIV through sexual conduct accounts for approximately 75 percent to 85 percent of the nearly 28 million infections of HIV. The probability of infection through sexual contact, although varies considerably appear lower sexually than through other routes. The possibility of sexual infection partly depends on the viral dose. Sometimes, transmissions depend on the method of transmission especially whether the virus permeates through blood or sexual secretions. In women, sexual transmission is higher than in men. According to AIFDSInfo (2009), oral sex is also a possible cause of transmission. While the risk of transmitting HIV through oral sex is lower compared to that of vaginal or anal sex, several studies indicate that oral sex can also lead to transmission of HIV.
Other possible ways that HIV can be transmitted include:
- Sexual irresponsibility manifested by having numerous sexual partners. This increases the risk of infection because higher number of sexual partners increases the risk sex having with an infected person.
- Having unprotected sex also increases the risk of having sex especially if the sexual partner is infected
- HIV can also be acquired through Sharing of sharp objects such as needles, blades, among others
Scope of the Problem in Missouri
Missouri is a state with a population of 5, 967, 100 people. The black population in Missouri is 643, 800 which is 38% of the total Missouri population Missouri’s State Black Annual AIDS case rate per 100,000 is 59.3 percent. 6,175 black people live with HIV in Missouri (National Black AIDS Awareness Day, 2012).
Like all American communities, African Americans face a number of challenges that lead to higher rates of HIV infection. In Missouri, socioeconomic issues associated with poverty leads to limited access to better healthcare, housing, and HIV education. These challenges increase the rates of HIV education increases the rates of HIV in Missouri area. Perhaps the biggest problem associated with HIV rates is caused by lack of awareness of the potency of the problem. In the city of St. Louis, 67 percent of affected African American youths were unaware of their status (AIDSInfo, 2009).
In addition to unawareness, the HIV victims also face the problem of stigma associated with being HIV Positive. Because of the social attitudes towards HIV, many victims dread the position of being branded social misfits and would rather hide their status than seek counseling or testing. With limited tests and counseling, youths may continue to spread the virus unaware of what of what their actions causes to the society (AIDS Info, 2009).
Solutions to the Problem of HIV/AIDS in Missouri
Several Black Community organizations founded for sensitizing the black community about HIV and other STDs. One such organization is the National Black HIVB/AIDs Awareness Day that was founded in 1999. The organization receives funding from the Center for Disease Control and Prevention. The aim of the program is to support capacity building assistance to black communities in order to elevate the problem of HIV/AIDS.
The organization holds a single day in the year to carry out HIV awareness campaign at the grass root level. The organization main goal is eliminating HIV/AIDS in the black community. Every year, approximately 20,000 African Americans in the United States test positive for HIV. Currently, the organization reports that about 100,000 black youths are living with HIV. The organization aims at increasing awareness of HIV by encouraging testing and counseling (National Black HIV/AIDS Awareness, 2012).
The National HIV and STD Testing Resources is another organization that aspires to eradicate the HIV menace in the United States. The Centers for Disease Control and Prevention (CDC) owns and operates the National HIV and STD testing Resources. The organization works in a Website that provides information about HIV and has information about all the available testing centers in the United States (National HIV and STD Testing Resources, 2012).
Another organization that plays a key role in raising HIV awareness is the center for Disease Control and Organization. CDC coordinates with partner organizations while pursuing high impact methods to accomplish the goals of the National HIV/AIDs to maximize the efforts of preventing HIV infection rates. CDC is careful of the methods they use so that they are directly applicable to environment chosen. Examples of CDC methods include partnership with other organizations to create awareness (Centers for Disease Control and Prevention, 2010).
The media also promotes HIV awareness in Missouri. Black radio stations boost HIV testing and the use of condom in the open radio discussions. Some conservative radio stations advocate for abstinence amongst the youth.
Government Role
The Obamacare is perhaps the biggest government’s attempt to solve the problem of HIV. Interestingly, Missouri voters overwhelmingly voted against the Obama administration in the 2012 elections. While Missouri voted against Obama, majority of the black residents threw their votes for Obama even though it did not count. One significance of Obama’s Healthcare reform focused people affected with HIV in Missouri. In the official website, the Affordable Healthcare Act envisions to provide healthcare for an estimated 1.2 million people living with HIV in the United States.
In Missouri, the HIV treatment community views the Affordable Healthcare Act as an important step in the fight against HIV epidemic. The Department of Health and Human Services estimates that only thirteen percent of people affected with HIV/AIDS have access to health insurance on private basis. Twenty four percent of patients of HIV have no health insurance coverage at all. The absence of health insurance on the part of the patients indicates that they are particularly vulnerable to challenges arising from sudden attacks and access to proper medical care.
It is for this reason that the Affordable Healthcare act acts as a beacon of hope for these Americans. It expands access to medication to victims as well as their families. For victims with low incomes, access to Medicaid is guaranteed. The same service is also offered to those with preexisting medical conditions.
Challenges of the HIV Issue amongst Health Workers
All social workers agree that client safety is their paramount responsibility. They also agree that a common approach for realization of this goal is elusive. Perhaps, casework practice is the most reliable way that social workers get the hands on way of dealing with HIV. Casework is problem-oriented approach that employs the use of situational cases that social workers can use as examples of the real world. The challenge arising from casework is the uniqueness of cases that health workers handle. It is thus important for health workers to know the dynamics that play out in different cases that they handle. While doing this, health workers grapple with personal values, biases, and experiences with respect to different situations. These issues are impactful on how health workers handle their work with the people in need. Still Linzer (1999) has posited the funding for the much needed methods is often a subject of intense political opinion. As a s health worker, the sole responsibility it to work with the limited resources that are available.
In general, old people are aware of their closeness to death; this forces them to grapple with the thought of death. However, the rest of the population has extremely little awareness of death unless they have faced it through a close family member or friend. Personally, I think people’s view on death depends on cultural values and individuals humanity. The more love an individual has for humanity, the more gracefully they will die. However, I argue that death should not be forced on anyone. HIV is not a ticket to death; it is not beyond control and should not be the reason for depression and anger amongst the people affected.
African Americans continue to experience higher rates of HIV than any other social group on the United States because of factors such as unawareness, social economic problems, poverty, limited education and the societal pressure of living with HIV. In order to wipe out HIV, services such as youth sex education, increased tests and improved economic situation will be required to reduce idleness and irresponsible sexual behaviors.
According to Boykin& Harris (2006), more than a decade after the renowned sexual revolution and the beginning of the AIDS epidemic, the United States is still a nation in denial about the need for sex education. Instead of talking about issues such as homophobia, AIDS, and shared responsibility to handle these challenges, America talks about irrelevant issues (p.5). Like Keith Boykin and Harris point out, the problem of HIV in Missouri is that it garners limited attention.
Michael Sidibe, UNAIDS Executive Director asserts that prevention of AIDS is only possible after a revolutionary change that combats public hypocrisy on sexual issues. In addition, there should be a higher degree of AIDS expertise and understanding, promotion of sexual and reproductive rights by movements (UNAIDS, 2012). The relationship between governments, civil society, and the public creates an opportunity for financial resources to be available. These resources can then be channeled to offer solutions for problems arising out of HIV and AIDS. The absence of the partnership between the civil societies, government, and the general public inhibits effecting combating of the HIV menace. For the most part, the HIV problem is still, a class struggle between the rich and the poor. Unless the poor blacks are economically empowered, higher rates of HIV cases will be unavoidable
Ethics When Working With HIV patients
It takes special level of caring to be able to provide care for those people that have been rejected by the society and judged on reasons that make them unworthy to fit in with regular people. However, there is much more to nursing than caring. Still, the prison setting makes the realization of nursing goals virtually impossible. Aspects of nursing practice such as safety of the nurse and patient, privacy of information, and the relationship between the nurse and patient in a mutual and professional way is compromised for the sake of security of the people and their family.
Some ethics scholars argue that ethics as of philosophy, involves two types of principles that comprise deltiology and teleology. Detelogical principles assume that behaviors are inherently right or wrong. For this reason, it is the responsibility others to determine the ethicality of actions of others. On the other hand, teleological principles consider the consequences of actions, decisions as based on expected rewards or punishments. In business, many scholars believe that managers apply delelogical and teleological criteria when making ethical judgments. Several scales are used to measure ethics including cognitive moral scales, developmental scales, developmental scales, multi-dimensional scales among others (Shanan& Hyman 2003).
Dobson (2007) writes that ethics can be integrated into business in two ways. One way is through action-based approach and the other way through established rules, that governs the management’s actions. The established are usually enshrined in the business’ code of conduct or code of ethics. In contrary to the established rules, the action-based approach leaves ethics as a concern of the character and motivations of the person concerned. In this view, moral behavior separates from the law constrains and adopts individual rationality as the premise of operation.
Susan Trosman borrows from ANA, 2007 the “purpose of medicine is to diagnose, comfort, and cure” It requires that a strong personal commitment to the ethical standards and love for the profession is mixed with a genuine desire to save mankind from suffering that nursing facility can realize the already established standards. All health care professionals worldwide are required to ensure a 'duty of care' as is also expected of other professionals; such as in financial services, however apart from the legality of ensuring a duty of care, a moral and ethical obligation to ensure 'duty of care' should be considered as a basic characteristic quality of the health care professional. Advanced ethics pertaining to nursing should not just be regarded as a compliance challenge, but rather as an integral part of a nursing professional’s value system and deep-rooted beliefs.
Primary consideration will be allocated to the topic of confidentiality which is perceived as one of many basic ethical requirements needed in the health care environment. Confidentiality can be compromised or brought into question, when other ethical principles such as ‘harm to the patient’ are applied. Although a measure of trust is shown when a patient accesses medical assistance, the right of patient autonomy is a basic ethical consideration. According to a U.K. Clinical Ethics Network (UKCEN) governmental guideline, it is stated “The principle of respect for patient autonomy acknowledges the right of a patient to have control over his or her own life” (UKCHEN 2012, p. 1). This aspect relating to ‘control’ has significant relevance when considering confidentiality, and added to this concept; research considers ethical theories and their influence over confidentiality. A further topic under discussion will be the challenges pertaining to cultural diversity, and how such diversity influences the application and measure of advanced ethics.
Virtue ethics directs attention to the nurse and how they would react when faced with challenging situations involving their responsibility to maintain patient confidentiality. The NHS Scotland’s Advanced Nursing Practice Toolkit, points out that this ethic “emphasises the moral character, or virtues of the individual enacted” (NHS Scotland 2012, p. 2). This publication goes on to expand on ‘virtue ethics’ as relating to good character found within the health professional resulting in “doing the right thing”. Perhaps the importance of this ethic can be attributed to the ability of this health professional to determine what is truly right and wrong; thereby disregarding own personal views and biases when applying a decision-making process to a challenge incorporating confidentiality. This can be seen when a culturally diverse patient attempts to influence the nurse’s decision making, in the event of potentially ‘life threatening information’ being withheld from family members due to cultural beliefs.
The principle of confidentiality incorporates several elements. According to the College of Registered Nurses of British Columbia’s publication (CRNBC), these elements include; the knowledge nurses have regarding what specific regulations apply to their functions/duties, and the necessity to comply with the relevant legislation. Moreover, client’s personal and medical data and information only to be obtained on a “need-to-know basis” (CRNBC 2012, p. 1), and that the client is aware of their rights relating to this information. Additionally, the client’s agreement is also needed pertaining to its collection, utilization and disclosure, and that they are aware of such information being shared amongst relevant personnel, followed by the nurses responsibility to respect a client’s legislated rights to access and amend such information. Another element pertaining to the principle of confidentiality concerns the protection of such information obtained within the nurse-client relationship being contained within ‘relevant personnel’ (above), except when a specific ethical or legal obligation materializes that obligates the sharing such information outside of the aforementioned relevant personnel. In this situation nurses must disclose such additional measure to the client, especially if there is a significant risk of harm or loss either to the patient or others; thereby the nurse must utilize a process of ethical decision-making before such disclosure. In addition, in the event of legal obligation, either by legislation or law court actions, disclosure must be restricted to the minimum necessary to ensure compliance to such legal obligation; and also the minimum personnel needed to be informed. Finally, the nurse may only access such information that is relevant to their duties, and in the event of others abusing the principle of confidentiality; must take corrective action (p. 1). Also relevant regarding the abuse of confidentiality, is the application of a justified ‘breaking’ of confidentiality to other cases similar to the case where ‘reasonable limits’ was deemed ‘overtaken’. The Queensland government guidelines stipulate that decisions regarding access need to be enacted on a “case by case basis” (Queensland Department of Health 2012, p. 5)
Reasonable clause
This brings the study to the concept of ‘reasonable limits’. This issue may be perceived as a ‘grey area’ due to different interpretations regarding what is meant by ‘reasonable’. The Reasonable limits clause in the English legal system allows the government to limit individual’s rights on what is famously called the Charter Rights. The reasonable limit clause allows the government to prevent occurrence of activities that may jeopardize the safety of other people. Under the reasonable limits, law to have access to intelligence information accustoms the government. This requirement is justified and accepted in a democratic society as long as there is proof of the security issues at hand. However, while employing the reasonable limit clause, there is need to account for the proportionality of the situation. The concern should be whether the infringement of the rights to privacy of the individual is weightier than the security of the issue at hand. The infringement of an individual’s rights to privacy must be justifiable for the sake of reasonable clause limit to stand. In the event that the client’s safety is compromised due to the application of confidentiality, nurses must employ a process of ethical decision-making before disclosure. As has been already noted, legally binding requirements can also extend beyond ‘reasonable limit (Daniels, 2012).
Recommendation for HIV Problems
The primary concern of HIV activists should be reducing high-risk behaviors such as unprotected sex, unfaithfulness. Scholars report that counseling reduces the self-reported risk behavior. With counseling, the affected individuals face the challenge of taking a personal motivation to change their own lives (Colfax, 2006).Counseling works by channeling thoughts from stress to positive thinking. Moreover, counselors receive training that enabled them to handle different cases. In Missouri, limited counseling results to high-risk behavior due to stress and vulnerability.
Accordingly, a change in lifestyle can make a difference in HIV rates in Missouri. Livelihood includes garnering skills to become productive. In South Africa, studies conducted found out that empowering young people economically reduced the rate of HIV by almost half. Poverty was realized as a possible cause of HIV (Population Council Inc, 2011). Based on the South African experiment, I support economic stimuli programs that will send the majority of idle youths to school and to vocational training institute. That way, there will be reduced rates of infections since idleness will be reduced.
CDC recommends working with African American leaders from every sector of the society to rally the people of color against HIV and deliver ethnically suitable campaigns and messages. Developing homegrown solution will also help a fantastic deal in solving the problem since different cultures have different ways of doing things.
Conclusion
The paper has explored the problem of HIV in the Missouri by providing statistics of the problem as well as highlighting challenges faced about HIV in the black community of Missouri. At the end, the paper presents recommendation on some of the issues in order to tackle the HIV problem in Missouri. Based on the research, this paper recommends an holistic approach toward tackling the issue of HIV. This holistic approach should incorporate the government, civil society, and the individuals. The nursing and health fraternity at large must act with reasonable care and respect to the rights of the individuals affected with HIV.
References
AIDSinfo. (2009, September). Oral Sex and HIV Risk [CDC HIV/AIDS Facts]. Retrieved September 12, 2012, from http://www.cdc.gov/hiv/resources/factsheets/pdf/oralsex.pdf
Centers for Disease Control and Prevention [HIV and STDS control]. (2010). Retrieved May 8, 2012, from http://www.cdc.gov/hiv/topics/aa/
Colfax, G. (2006, March). Does Counseling HIV-Infected Persons Lead to Lower-Risk Behavior? HIV InSite Knowledge Base Chapter, Vol. 4(No: 345), p 340- p 460.
Keith Boykin, & Harris, E. L. (2006). Beyond the Down Low: Sex, Lies, And Denial in Black America. New York: Avalon Publishing Group.
KMOV.com. (2011, October 4). HIV/AIDS infection rate among African American women alarmingly high in St. Louis . KMOV-TV, Inc. Retrieved from http://www.kmov.com/news/health/HIVAIDS-infection-rate-among-African-American-women-alarmingly-high-in-St-Louis-131118338.html
Lyon, M. E., & J. D’Angelo, L. (2006). Teenagers, HIV, And AIDS: Insights from Youths Living With the Virus. WestPort, KT: Praeger Publishers.
MedicineNet. (2012). MedicineNet [Medicine]. Retrieved May 14, 2012, from http://www.medicinenet.com/human_immunodeficiency_virus_hiv_aids/article.htm
National Black HIV/AIDS Awareness Day [Community Advocay]. (2012, February 2). Retrieved May 7, 2012, from http://www.blackaidsday.org/about_nbhaad.html
National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention. (2010, September). Prevention Challenges. In HIV among African Americans [CDC National Prevention Information Network]. Retrieved May 14, 2012, from http://www.cdc.gov/hiv/topics/aa/resources/factsheets/pdf/aa.pdf
National HIV and STD Testing Resources [National HIV and STD Testing Resources]. (2012). Retrieved May 10, 2012, from http://www.hivtest.org/aboutus.aspx
The Population Council, Inc [Financial literacy/lLivelihoods]. (n.d.). Retrieved November, 2011, from http://www.popcouncil.org/topics/fl.asp
Royce, R. A., Seña, A., Cates, W., & Cohen, M. S. (1997, April). Sexual Transmission of HIV. The New England Journal of Medicine, No: 3546, :1072-1078.
UNAIDS. (20111). Reducing Sexual Transmission [UNAIDS ]. Retrieved May, 2012, from http://www.unaids.org/en/targetsandcommitments/
CME Resource. (2011). Ethical Decision Making. Sacramento, California. United States.
CRNBC. (2012). Practice Standard for Registered Nurses and Nurse Practitioners. College of Registered Nurses of British Columbia, Vancouver BC V6J 3Y8. Canada.
Daniels, N (2005). Policy Challenges in Modern Healthcare. Rutgers University Press. http://www.rwjf.org/coverage/product.jsp?id=14908
Gillihand, M. (2010). A Systematic Approach to Ethical Decision-Making for Nurses Confronted with Ethical Problems Involving Elder Abuse. The University of Texas at Arlington,
Arlington, TX 76019-0407. United States.
