Introduction
Traditionally, HIV prevention programs have focused on promoting personal behavioral change. For example, community-based organizations have often focused on providing therapy and counseling services to AIDS victims and other high-risk populations (New York City AIDS Memorial, 2013).
Although most of their interventions have shown remarkable success, this paper shows that most personal behaviors, which contribute to the spread of HIV, occur within a broader context of social, economic and political interactions. Using this analogy, this paper shows that, although personal behaviors are the same, the context where people make decisions about their sexual health has dramatically changed. This development has created the need for introducing the social-ecological model (SEM) in curbing the increased rates of HIV infection in some communities.
To understand this issue, well, this paper focuses on the Brooklyn community (New York) by exploring how new health interventions (based on the SEM) could curb the AIDS epidemic in the region. However, before embarking on the details of this analysis, it is important to understand this community and the health issues that affect it.
Population and Health Issue
New York reports the highest cases of new HIV infections in America. It has an estimated 4,000 new infections yearly (New York City AIDS Memorial, 2013). Demographic analyses of these statistics show that many new infections affect young men, aged from 20 years to 30 years. Brooklyn is among the most affected communities in the state. Its population is 2,471,000 people who have a median income of $43,000, per family (Point Homes, 2014).
About 880,000 households characterize the region, but a quarter of Brooklyn inhabitants live below the poverty line (Point Homes, 2014). Although the HIV prevalence in the community has decreased by about 50% in the last decade, current statistics show that the trend is slowly reversing (Scutti, 2013). Health experts say the increased complacency among young people to take preventive measures from contracting the HIV virus has contributed to the increased infection rates in the community (New York City AIDS Memorial, 2013).
For example, Scutti (2013) says many young people are starting to believe that HIV “is just a matter of taking one pill a day” (p. 3). Such ideas have prevented some people from practicing safe sex. Since these facts are disturbing, there is a need for a broad and inclusive approach to promote HIV prevention in the community.
Indicators of Health Issue
Brooklyn accounts for about 31% of all HIV-related deaths in New York (Norwood, 2013). In 2012, experts said that AIDS was the ninth leading cause of death in the community. The highest rates of new infections occur among homosexual men. Detailed statistics show that the rates of new infections (within this demographic) have increased from 232, in 2001, to more than 400, in 2011 (Scutti, 2013).
The high incidence of new HIV-related cases in the region threatens inter-generational existence because most new infections affect young people. Its high morbidity also affects family relations and community productivity in the region because families lose their breadwinners to the epidemic. This situation shows that HIV/AIDS affects the economic and social well-being of the Brooklyn community.
Social Health Factors, which Influence New Rates of HIV Infection in Brooklyn
Dean & Fenton (2010) say that complex and integrated social and economic factors influence health outcomes in a community. For example, a patient’s position in a social hierarchy could influence his health outcome. Using this analogy, Dean & Fenton (2010) say the increasing rate of HIV infection in Brooklyn is a product of integrated and complex social and economic health factors.
Therefore, to decrease the HIV prevalence in the community, it is important to understand how these factors affect people’s sexual health. This paper identifies income and stigma as the main social factors that affect new rates of infection in Brooklyn.
Income and Social Status
Income and social status have not only had a huge impact on HIV prevalence in Brooklyn, but around the world too. For example, many researchers have undertaken studies in Sub-Saharan Africa and affirmed their impact on HIV prevalence in the region (Dean & Fenton, 2010). Studies in the US have not shown much difference either because researchers say that SES significantly affects health outcomes in the region (Dean & Fenton, 2010).
Similarly, social and economic differences affect the HIV prevalence in Brooklyn. Findings show that its prevalence is mostly higher among people of low SES. Such outcomes stem from earlier findings, which show that many people who hail from low SES practice risky sexual behaviors, which increase their exposure to HIV. For example, the American Psychological Association (2014) says many low SES people engage in sexual activities earlier than their counterparts who come from wealthy families.
Similarly, it says such people are less likely to practice safe sex (condom use) compared to their counterparts from high SES (American Psychological Association, 2014). There is also a high correlation between high stress levels and risky sexual behaviors (mostly affecting people from low SES). Similarly, unstable housing has a direct correlation with a high HIV prevalence rate because research shows that most homeowners suffer a lower exposure to HIV than their counterparts who do not own houses (American Psychological Association, 2014).
Based on the above findings, SES easily determines the ease of contracting the HIV virus in the Brooklyn community. Moreover, it affects the health care quality that a patient would receive after infection (people of higher SES often have more treatment options compared to their counterparts from lower SES).
Stigma
People who suffer from HIV and AIDS in Brooklyn experience stigma from community members. This stigma may manifest in community members having negative attitudes towards AIDS victims. Many studies have identified the correlation between stigma and health-seeking behaviors that affect HIV management (AVERT, 2014).
They show that stigma mainly affects HIV testing and treatment procedures (AVERT, 2014). For example, communities that stigmatize AIDS victims often make their members fearful about taking tests. Similarly, such communities often prevent their members from disclosing their status. The same factors prevent infected people from taking anti-retroviral drugs or seeking proper health care. In fact, one study showed that most people who come from communities that stigmatize AIDS victims reported poor access to care (four times lower than people who hailed from communities that did not stigmatize AIDS victims) (AVERT, 2014).
Broadly, stigmatization affects the detection, management, and the spread of the AIDS epidemic in Brooklyn. Based on these intrigues, it is important to use a model that acknowledges the above challenges in promoting health programs that reduce HIV incidences. The SEM fits this profile.
The Significance of the SEM in Addressing the Health Issue
The SEM recognizes that sexual behaviors occur within a wider framework of social and physical surroundings. Its pillars include “interpersonal, organizational, community, societal and policy levels” (Meyers, 2007, p. 4). The diagram below outlines the basic structure of the model
This paper uses the above model as an effective framework for managing HIV in Brooklyn. For example, regarding safe sex, the SEM recognizes how peers and family members influence a person’s inclination to use condoms. Similarly, the same model acknowledges the role that the physical environment plays in influencing the same behavior because the access to condoms also influences a person’s quest to insist on safe sex.
These examples show that the SEM situates a person within multiple interaction levels. Using the above model, this paper proposes different levels of intervention for curbing the AIDS epidemic in Brooklyn, as the table below shows
Proposed Interventions
This paper proposes interventions across all the SEM levels. These interventions build on existing health promotion frameworks and exploit existing competencies to promote positive health outcomes. The table below shows how each strategy merges with an SEM level
How the Proposed Interventions Address Public Health Services for HIV Prevention
Health institutions and community-based organizations have provided many infrastructural support structures to improve public health in Brooklyn (Hartley, 2012). For example, such organizations have constructed sidewalks and introduced public health education programs about HIV to improve the physical health of community members and increase awareness about HIV, respectively (Hartley, 2012).
Plans are underway to increase the scope of these initiatives and focus more on sexual health to help the inhabitants make better and informed decisions that would improve their sexual health and prevent the spread of HIV. The above-mentioned interventions seek to expand the scope of these programs by providing a holistic approach to HIV prevention in the community.
How the Society and Policy Levels of the SEM Contribute to the Proposed Interventions
The society and policy levels of the SEM affect interpersonal relationships in Brooklyn, thereby influencing people’s vulnerability to HIV. For example, policies affect the efficacy of HIV interventions because they affect the scope and depth of HIV prevention programs (Meyers, 2007). Similarly, policies could prevent condom distribution in schools and prisons, thereby undermining HIV prevention programs (Meyers, 2007).
In this regard, this paper makes sure that political players participate in the proposed health promotion programs. Moreover, this paper acknowledges the contribution that coordinated political systems make to improve HIV testing and treatment programs. At the community level, social norms may affect HIV prevention measures.
For example, these norms could influence condom use in the community, thereby making it difficult for health organizations to promote safe sex (Meyers, 2007). Moreover, this paper recognizes community competencies as a key pillar in the HIV fight. In this regard, the SEM considers how a community’s social norms influence health promotion programs.
The Significance and Application of SEM to Minimize HIV Infection Rates in Brooklyn
This paper highlights the need to adopt the SEM to decrease HIV infection rates in Brooklyn because the model includes all health stakeholders and presents new opportunities for minimizing the HIV epidemic (Virginia Department of Health, 2014). The SEM should offer guidance for introducing new HIV prevention programs, beyond the traditional public health structures that characterized past health initiatives in Brooklyn.
Ideally, the newly proposed framework should shape prevention, policy and practice frameworks that underlie current and future HIV prevention initiatives in the community (Meyers, 2007). Indeed, by using the SEM, this study assumes that the proposed public health framework should address broader issues that affect HIV prevention, such as culture, personal behavioral choices, family influences, policy, and education (among other factors) (Dean & Fenton, 2010).
Stakeholders Included in the SEM Model
Government
The government is an important stakeholder in the above-mentioned health promotion model because it is instrumental in providing quality care for AIDS victims in Brooklyn. For example, since HIV/AIDS victims in Brooklyn face stigma, politicians could introduce rules and policies that prevent community members from practicing discriminatory practices against such victims.
For example, such rules should prevent employers from discriminating against AIDS victims during recruitment. AVERT (2014) says discriminatory practices stigmatize AIDS victims because it inhibits their access to quality care. Based on the above assertions, governments, politicians, and political systems play a significant role in reducing (or increasing) the momentum for HIV prevention. This way, the political class is an important stakeholder in the proposed health care model.
Mass Media Outlets
This paper has already shown that one reason for the rapid spread of HIV, in Brooklyn, is the stigma associated with the health problem. This study recognizes that the media have a role to play in reducing the negative perceptions and attitudes associated with HIV and AIDS. In this regard, the media is an important stakeholder in HIV prevention in Brooklyn. For example, they could avoid using discriminatory language to refer to HIV/AIDS, and their victims (AVERT, 2014).
Similarly, since this paper proposes strategies that involve inter-community and inter-group partnerships, media outlets could help to disseminate information (improve communication) between them. This way, the media is an important stakeholder in making sure HIV prevention programs work in Brooklyn.
How the Principles of Community-based Participatory Research Apply to the Proposed Interventions
Community-based participatory research proposes the use of multiple approaches for health promotion (Virginia Department of Health, 2014, p. 1). The interventions proposed in this paper appeal to the ideals of this model because they recognize the community as a unit of identity, and build on a shared platform for health promotion.
Similarly, as outlined by the principles of the community-based participatory research, this framework builds partnerships and capacity-building initiatives, disseminates important information about health care resources to important stakeholders, and involves a long-term process and commitment of all concerned stakeholders (Virginia Department of Health, 2014, p. 1).
How the Proposed Interventions Address Two of the Essential Public Health Services
Poor coordination and “stagnant” competencies have made it difficult to identify new approaches for fighting HIV in Brooklyn. The interventions proposed in this paper address these main issues as outlined below.
Coordination
The above-mentioned proposed interventions aim to improve coordination among groups and community organizations to manage the AIDS epidemic in Brooklyn. Coordination is an important addition to the HIV fight because in the past, many organizations undertook isolated efforts for fighting HIV. Improved coordination should improve the effectiveness of existing and future health interventions (New York City AIDS Memorial, 2013).
Improving Competencies
The interventions proposed in this paper seek to improve the competencies of health workers by encouraging them to attend workshops and other educational forums that would teach them about effective ways of undertaking their duties. This approach should improve health care services (testing and patient care) as a strategy for managing the AIDS epidemic in Brooklyn (New York City AIDS Memorial, 2013).
Discussion and Conclusion
The SEM suggests that effective HIV prevention strategies should appeal to different levels of its structure. This idea stems from the assumption that behavioral change is a product of encounters with groups, or social and political systems. Therefore, an effective approach to HIV prevention exists if health care providers create coordinated disease prevention strategies that make it easier for people to encounter HIV prevention programs as they undertake their daily duties.
This analogy is true for health prevention strategies that aim to reduce HIV infection in Brooklyn. In line with this reasoning, highlighting the role of social issues in shaping people’s vulnerability to the virus is the key to creating effective HIV prevention strategies. The above-mentioned interventions are likely to succeed because unlike past approaches that relied on one intervention to fight HIV, the SEM uses multiple perspectives to meet the same goal. This means that even if one approach may not yield positive health outcomes, another one will. Therefore, this model is likely to boost health interventions for fighting HIV in Brooklyn.
References
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Dean, H., & Fenton, K. (2010). Addressing Social Determinants of Health in the Prevention and Control of HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis. Public Health Rep, 125(4), 1–5.
Hartley, M. (2012). Building a Better Sidewalk. Web.
Meyers, K. (2007). Issue Brief: Racial and Ethnic Health Disparities. Web.
New York City AIDS Memorial. (2013). HIV/AIDS: An Evolving Epidemic in New York. Web.
Norwood, C. (2013). Growing Disparities in AIDS Deaths in NYC – A Health People Study. Web.
Point Homes. (2014). Brooklyn. Web.
Scutti, S. (2013). HIV in Brooklyn on the Rise, Particularly Among Borough’s Young Black Gay Men. Web.
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