Effectiveness of HIV Prevention Programs in NY State - Research Proposal Example

The Effectiveness of HIV Prevention Programs in New York in Preventing and Reducing HIV Infection among Women Research Paper Course Title Name of Professor Date of Submission Introduction Greater concern for HIV epidemic worldwide has motivated HIV policymakers and supporters to examine HIV prevention programs among women in the United States and to look at possible solutions. It is widely known that gender and income inequality (i.e. poverty) are two major aspects that influence HIV risk among the female population (Smith, 2008, para 2-3). This research paper will focus on HIV policy and prevention programs that could have a considerable influence on the status of HIV among women in New York State. First, the existing HIV prevention programs that incorporate gender-based aspects, especially those related to low educational level, domestic abuse, and poverty; and, second, the HIV surveillance program of the Centers for Disease Control and Prevention (CDC). Hence, the paper will try to answer three research questions: (1) Does current HIV prevention programs in New York State consider gender issues, especially in relation to issues confronting at risk women, such as poor education, domestic abuse, and poverty? (2) How effective are HIV intervention programs in NYC in preventing and reducing HIV prevalence among women? (3) Does the HIV surveillance system of the CDC show more precisely the facts behind the HIV epidemic and women’s needs in NYC? Basically, this research paper discusses and analyzes existing HIV prevention programs in New York State that are specifically designed to address the specific needs of HIV-infected and at risk women. Background New York State had roughly 11,000 known cases of HIV by 1987, comprising 30% of the total HIV cases in the U.S. Most of these cases take place in New York City, where HIV is the leading cause of death in males aged 24 to 45 and women aged 25 to 29 (NYS AIDS Advisory Council, 2005, 13-14). However, as time goes by, HIV has become more and more of a disease of women. The prevalence of HIV infection among women in New York has rose considerably over the recent decade. In 1999, female teens and adult women comprised roughly 26% of HIV cases reported in the state, in comparison to 19% in 1999 (NYS Department of Health, 2004, 24). HIV is becoming more and more prevalent among those belonging to ethnic minorities, especially women. Women of color comprise a large portion of new HIV diagnoses. According to the New York State Department of Health (2004, 24): Among cumulative female AIDS cases in New York State through June 2000, 53.7 percent are Black; 30.9 percent Hispanic; 14.9 percent White; 0.3 percent Asian/Pacific Islander, and 0.03 percent Native American. The leading cause of HIV infection for women is intravenous use of substance or drugs; though, a growing number of new HIV diagnoses are caused by heterosexual interaction with some admitting such interaction as their main HIV risk (NYS Department of Health, 2014). The CDC finds out that the percentage of new cases of HIV in the U.S. among the female population has almost quadrupled, in the recent decade. Moreover, prevalence of HIV varies significantly by race. Here are several important facts (Smith, 2008): • Non-white women comprise the bulk of new HIV cases among the female population in NYC. • Latinas comprised a startling 82 percent of overall HIV diagnoses for women in 2005. • According to the 2004 NYC Department of Health report women comprise 32 percent of new HIV cases. With such reports the New York State Department of Health/AIDS Institute developed and carried out programs designed to concentrate on women, especially those belonging to minority groups, highly vulnerable to HIV infection and those already infected with HIV, their families and sexual partners. Major Findings This section provides a comprehensive analysis and discussion of existing HIV policies and prevention programs for women in the state of New York. The analysis will focus on three areas, namely, the level of gender sensitivity of these existing policies and programs, whether they are effective in preventing and reducing the prevalence of HIV infection among women in the state, and whether the HIV surveillance system of the state reflects the needs and realities of women living with HIV. (1) Do HIV prevention intervention programs address gender and how other socioeconomic factors (education, income, adverse life situations) influence HIV risk? There are currently 18 health care services available for HIV-infected individuals in the state of New York, according to the New York State Department of Health (2014) website. Yet, only four among these 18 HIV-focused health care services address gender or consider HIV-infected and at risk women: (1) Community-Based HIV Prevention and Primary Care Services; (2) Designated AIDS Centers; (3) Family-Focused HIV Health Care for Women; and (4) Legal and Supportive Services for Individuals and Families Living with HIV. In 1989, the Community HIV Prevention and Primary Care Initiative was founded to address the increasing demand for community-oriented HIV programs. The objectives of this program are to educate those vulnerable to HIV, ensure the readiness and accessibility of regular HIV checkup, encourage timely access to organized, inclusive and constant care, and build provider capability to provide on-site premium HIV health care services (NYS Department of Health, 2014). Almost 5,000 HIV-infected individuals obtained HIV primary care services and medical case management from 2010 to 2011 through healthcare professionals subsidized by this program. The program is gender-sensitive and has already served numerous HIV-infected and at risk women. According to recent data, the program is still successful in serving vulnerable groups—homosexuals, women, and ethnic minorities (e.g. Hispanics, African Americans, etc.) (NYS Department of Health, 2014). The Designated AIDS Centers are initiatives that function as the centers for a range of community- and hospital-based care services for HIV-infected individuals. These programs offer advanced, interdisciplinary outpatient and inpatient services organized through hospital-centered case management. These programs serve women with special needs, especially those pregnant ones. The AIDS Center program was created and continues to be a patient-oriented initiative that can change with the patient’s requirements and demands in the evolving health care setting (NYS Department of Health, 2014). AIDS Centers fully cater to the primary care needs of HIV-infected and at risk women. The Family-Focused HIV Health Care for Women program is an inclusive approach aimed at addressing the requirements and demands of HIV-infected women. The program aims to enhance access to health care services, facilitate the availability of primary care, and generally to boost health status through promotion and compliance to treatment programs. Furthermore, a principal result of such program is to lessen vulnerability to or likelihood of perinatal HIV transmission. This program is a cohesive framework that consolidates women’s health services, primary care, and pediatric services for newborns at risk of HIV infection (NYS Department of Health, 2014). Interdisciplinary, all-inclusive groups bring together medical case management, therapeutic counseling, HIV-focused care and other services to cater to the specific and challenging social and medical problems confronted by HIV-infected women and their families. It was reported in 2011 that a group of seven health care units, based mainly in New York City, offer subsidized amenities (NYS Department of Health, 2014). HIV-infected women and their families are entitled to these services. The Legal and Supportive Services for Individuals and Families Living with HIV are an initiative aimed at providing inclusive legal services for both individual and family consisting of legal counsel in issues like education, health care, housing, domestic abuse, discrimination, and so on (Lune, 2007). Most importantly, legal professionals inform women about legal concerns and offered services. The target group for this initiative is families facing HIV-related problems. HIV-infected men and women and their dependents are entitled to use these services. In sum, as stated in the NYS Department of Health (2014) website, only these four health care programs specifically address the special needs of HIV-infected and at risk women. However, in the document released by the NYS Department of Health in 2004—Women’s Health Programs in New York State-- there are two programs, besides the four previously discussed, that address the needs of HIV-infected and at risk women. These are Centers for Excellence in Pediatric HIV Care and Community Action for Prenatal Care (CAPC), The Centers of Excellence in Pediatric HIV Care are leading community-based and localized programs aimed at preventing perinatal HIV transmission and to take care of HIV-infected pregnant women and their at risk children. In order to accomplish this purpose, a Center facilitates accessibility of its services, offers seminars for birth clinics and community care givers, and receives recommendations of inclusive care for HIV-at risk infants and HIV-infected children (NYS Department of Health, 2004). Likewise, the Community Action for Prenatal Care (CPC) program is intended to create community associations focused on the prevention of negative birth effects through the enrollment of highly vulnerable women into the prenatal care program. The program is focused on the areas of Buffalo, Manhattan, Brooklyn, and Bronx where the number of women giving birth without prenatal care and the population of HIV-infected pregnant women are significantly high (NYS Department of Health, 2004). Numerous families facing HIV-related problems in the state of New York are also confronted by problems of family disruptions, mental disorder, domestic abuse, alcohol and drug abuse, and poverty. These concerns, alongside access barriers and family duties, pose considerable hindrances to quality health care services. Many health care services are generally unable to understand that HIV usually spreads and distresses a number of generations and blood relatives have been mostly ignored. Besides observable health problems, families confronting HIV-related problems experience barriers to health care, poor housing arrangements, and joblessness (NYS Department of Health, 2004). Women confronting HIV-related issues experience family disruptions, mental disorder, domestic abuse, substance abuse, and poverty. Health care services for HIV-infected women are further made problematic by family problems and gender inequality that are different from those observed in men. These problems usually lead to disordered lives that bring about difficulties and insecurity in living arrangements (Gotbaum, 2003). Usually, women have the main duty for the nurture, care, and rearing of their children. Issues concerning children and family are usually given more importance than their own health problems. Besides tackling their health care problems, women with HIV usually confront challenging concerns like discrimination, everyday child care, and custody settlements. Most of the families confronting HIV-related problems in New York are single-parent families with women as both the primary caregiver and the breadwinner (The Henry J. Kaiser Family Foundation, 2014). Up until now, the biggest population of women facing HIV-related problems in the state of New York is comprised of those living under poverty, those belonging to ethnic minority groups and marginalized communities. Numerous of the women most at risk of HIV are also suffering from substance abuse, unplanned pregnancy, sexually transmitted diseases, poor nutrition, lack of education, and barriers to accessing quality social and health services (Mukheriea & Vidal-Ortiz, 2006). Numerous are involved in prostitution, have mental problems, or dispossessed/homeless. In addition, numerous at risk women in the state had experienced multi-generational maltreatment and violence. A considerable number of HIV-infected women have experienced domestic abuse, incest, and childhood sexual violence (McGarrahan, 1994). Vulnerable women in New York are usually jobless and have low educational levels. Being jobless or having difficulties accessing good employment opportunities forces numerous women to engage in prostitution and sexual contact with at risk males. Numerous women become destitute or homeless or imprisoned for substance abuse or drug-related offenses (The Henry J. Kaiser Family Foundation, 2014). HIV infection is specifically high among imprisoned women in New York State penitentiaries, majority of whom are detained for drug-related offenses. Researchers found out that incarcerated women are thrice more prone than their male counterparts to acquire hepatitis C and HIV. Majority of these women are living under poverty and belong to ethnic/racial minority groups (NYS Department of Health, 2004). Women with HIV in New York also do not have strong and sufficient social and familial support systems. Women involved in prostitution and substance abuse could be rejected by their families and peers. Newly transferred immigrant women could be stripped off of their cultural support privileges and secluded by language obstacles (NYS AIDS Advisory Council, 2005). Due to the burdensome responsibilities and pressures with which these women should deal with, it is easy to understand why HIV health care and intervention may not be prioritized. Different survival or sustenance needs for their children or dependents and themselves (e.g. housing, food, money, etc.) can leave them exhausted financially, physically, mentally, and emotionally, making them susceptible to HIV (NYS AIDS Advisory Council, 2005). (2) How effective are HIV intervention programs in NYC in preventing and reducing HIV prevalence among women? By the close of 2009, ten major metropolises comprised roughly 56 percent of the total number of HIV-infected women. Miami and New York had the biggest population of HIV-infected women: *image taken from The Henry J. Kaiser Family Foundation, 2014 As of December 2009, there were approximately 39,054 women in the state of New York infected with HIV. Women belonging to ethnic/racial minorities comprise roughly 89% of that figure (The Henry J. Kaiser Family Foundation, 2014, para 16). Majority of them were diagnosed of HIV between 30 and 49 years of age, and the leading variable related to transmission was heterosexual interaction (The Henry J. Kaiser Family Foundation, 2014). The Director of the AIDS Institute at the New York State Department of Health, Humberto Cruz, stated that “The earlier an HIV infection is diagnosed, the better the prospects are for maintaining an individual in good health and for preventing further transmission” (NYS Department of Health, 2011, para 5). He further said, “Our new HIV testing law should help get many more women tested as part of their normal health care routine. We also want all sexually active New Yorkers, including women, to be routinely screened and treated for sexually transmitted diseases (STDs), since persons with STDs are much more likely to acquire or transmit HIV” (NYS Department of Health, 2011, para 5-6). According to researchers, because of postponements of or late testing, a large number of individuals with HIV are diagnosed late, making treatment very difficult. Roughly 31% of female New Yorkers received a late diagnosis due to reluctance to seek one (NYS Department of Health, 2011, para 6). A new policy that was implemented in the state in 2010 requires the addition of HIV testing into regular care services all over New York. Testing should be offered to those looking for emergency services, inpatients, and those under primary care as an outpatient. The increasing number of HIV-infected and at risk women compelled New York State to promulgate policies and programs specifically catered to the special needs of these women (NYS Department of health, 2011, para 9-10). It seems that, based on available data alone, that HIV policies and intervention programs in New York State are successful in preventing and reducing HIV prevalence among women. By 2005, there were already approximately 53,500 HIV-infected women in the state of New York and roughly 31,200 girls and women are reported to be suffering from the disease (NYS AIDS Advisory Council, 2005, 7). These figures are believed to be inaccurate or too low because not all women have been tested for HIV. By 2009, the number of HIV-infected women in the state dropped from 53,500 to 39,054. This drop could be attributed to the more aggressive steps taken by the state as well as nongovernmental organizations to curb the continuously growing prevalence of HIV infection among women. (3) Does the HIV surveillance system of New York State reflect the needs and realities of women living with HIV? At present, only the states of New York and Nebraska have policies that are in line with the recommendations of the Center for Disease Control and Prevention (CDC) concerning HIV surveillance system. The CDC recommendations promote regular HIV testing (CDC, 2014). However, HIV organizations and women’s associations all over the United States, including New York, are demanding a reform in the CDC HIV Surveillance System because it does not precisely reveal the needs and realities of HIV and health care requirements of women in the United States. The National Women and AIDS Collective (NWAC) argues that the HIV surveillance system that is adopted by New York could be the underlying reason why women are not aware of, or prefer not to consider, their own vulnerability to HIV, thus adding to the epidemic among American women (Smith, 2008, para 15). According to NWAC, it is “based on an outmoded understanding of the epidemic from the early 1980s and… has only been minimally revised once during the 1990s… As such, it does not accurately report or reflect why women are increasingly becoming infected with HIV” (Smith, 2008, para 16-17). Health care professionals and supporters largely believe that women are acquiring HIV because they think they are the only sexual partners of their spouses or they are not aware of the HIV risk or sexual history of their male partners. NWAC and other organizations suggest modifying and improving the surveillance system of CDC so that a classification of ‘acquisition’ is included to the structure to acquire information on variables identified to boost women’s—especially those belonging to ethnic minorities and living in poverty—vulnerability to HIV infection, irrespective of thought or known behavioral risks (Smith, 2008). An acquisition classification would help the surveillance system to gather information on how women get HIV—involving variables like poverty, incidence of HIV, and location—in contrast to concentrating only on how HIV is passed on thru risky behavior. Summary of Findings Based on the data gathered, New York still has the biggest population of women living with HIV. There are several specialized or focused agencies or organizations in New York State that address the specific needs and demands of women living with HIV. These organizations are highly aware of issues that confront HIV-infected or at risk women, such as family disruptions, poor nutrition, low level of education, substance abuse, domestic violence, and poverty. It has been reported from current studies that women confronting such problems are more at risk of HIV infection. In terms of effectiveness, there are no references or sources that exactly specify whether these organizations are effective in reducing or preventing HIV infection among women in New York. However, based on available statistics, the number of HIV-infected women in New York dropped from 2005 to 2009. This reduction may be attributed to the emergence of these organizations since the state of New York and NGOs began to aggressively tackle the problem when such troubling numbers of HIV-infected women were reported. As regards New York’s HIV surveillance system, it has been criticized for failing to accurately reflect the realities and needs of women living with HIV. This is due to the fact that the state’s surveillance system is modeled after that CDC, which, in turn, is riddled with limitations or weaknesses. Basically, the surveillance system fails to precisely identify the underlying reason why women acquire HIV in the first place. It lacks what the NWAC refers to as ‘acquisition’ classification. Hence, upgrading and modification of the HIV surveillance system is largely recommended. Conclusions The severity of the prevalence of HIV infection in the state of New York is widely recognized. Until now, New York has the biggest population of HIV-infected women across the United States. Nevertheless, the health care services in New York for individuals suffering from HIV is strengthened by a wide array of women-focused social provisions with the objective of offering comprehensive and multicultural HIV care services for HIV-infected women and their families. In spite of the dedicated efforts of advocates, sponsors, and providers, the prevalence of HIV among women in New York keep on increasing, and some women, especially women of color, have problems accessing quality health care services. Absence of synchronized structures of services for women and discrimination are still the leading obstacles to successful HIV intervention programs for women all over the state of New York. Sexual violence and drug abuse make women more at risk of HIV. Poverty makes life difficult for women, especially in terms of finding jobs, good education, housing, and health care services. Therefore, much work is still needed to ensure that the needs of women living with HIV are fully addressed. References Centers for Disease Control and Prevention (CDC) (2014). State HIV Testing Laws: Consent and Counseling Requirements. CDC, http://www.cdc.gov/hiv/policies/law/states/testing.html Gotbaum, B. (2003). Women and HIV/AIDS in New York City: The Hidden Epidemic. NYC Gov., http://www.nyc.gov/html/records/pdf/govpub/2681women_and_hiv_aids_in_nyc.pdf. Lune, H. (2007). Urban Action Networks: HIV/AIDS and Community Organizing in New York City. Lanham, MA: Rowman & Littlefield. Retrived from google book McGarrahan, P. (1994). Transcending AIDS: Nurses and HIV Patients in New York City. Philadelphia: University of Pennsylvania Press. Mukheriea, A. & Vidal-Ortiz, S. (2006). Studying HIV Risk in Vulnerable Communities: Methodological and Reporting Shortcomings in the Young Men’s Study in New York City. The Qualitative Report, 11(2), 393+ New York State Department of Health (2004). Women’s Health Programs in New York State. NYS Department of Health, http://www.health.ny.gov/community/adults/women/womens_health_directory/docs/womens_health_directory.pdf New York State Department of Health (2011). Nearly 40,000 Women in New York Living with HIV/AIDS, More than Any Other State. NYS Department of Health, http://www.health.ny.gov/press/releases/2011/2011-03-09_hiv_women_awareness_day.htm New York State Department of Health (2014). Health Care Services. NYS Department of Health, http://www.health.ny.gov/diseases/aids/general/about/hlthcare.htm New York State AIDS Advisory Council (2005). Women in Peril: HIV & AIDS The Rising Toll on Women of Color. NYS AIDS Advisory Council, http://www.health.ny.gov/diseases/aids/providers/workgroups/aac/docs/womeninperil.pdf Smith, K. (2008). Current HIV Prevention Policy: Initiatives that Affect Women. The Body, http://www.thebody.com/content/art45492.html. The Henry J. Kaiser Family Foundation (2014). Women and HIV/AIDS in the United States. The Henry J. Kaiser Family Foundation, http://webcache.googleusercontent.com/search?q=cache:http://kff.org/hivaids/fact-sheet/women-and-hivaids-in-the-united-states/ Read More