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, the 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) has led to the establishment that, Montrose is one of the ten greatest neighborhoods in the country (High Beam, 2011). Nonetheless, Montrose has been very accommodating of the gay community, with several gay restaurants and bars dotted across the neighborhood.
In 1985, it was established that the 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 the 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 center of this study because this paper seeks to address AIDS as a special health concern affecting the gay community in the 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 contracting AIDS. These sexual habits have not only led to high AIDS prevalence in the region but it is also 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 suffers high AIDS incidences because 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 are attributed to the long periods that gays have lived in the Montrose area. In addition, the liberal nature of the Montrose community, and its accommodation of gay people, is seen as a contributing factor to the wide dynamics of the gay population group (High Beam, 2011). However, this study targets 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 is 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 the health concerns of both genders 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 the 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 socioeconomic status, therefore, poses lower levels of barriers to entry into the job market. In addition, 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 socioeconomic 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 they can protect 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 fewer 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 with 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 center 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 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, on top of outlining 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 the fight against 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 for AIDS only after they have experienced the symptoms of the disease. This means that they rarely seek health services in the early stages of the treatment, but most importantly, as a prevention measure against the disease. Health personnel is 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 because 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 have therefore not been many 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 a 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 through the 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.
Nurses, about addressing the HIV crises in Montrose gay community, adopt the systematic approach embedded in the Minnesota intervention wheel. Before they embark on any practical action towards alleviating the HIV and AIDS scourge, they conduct surveillance of the public health problem. Concerning public health intervention towards addressing a health issue, surveillance “explains and monitors health problems through continuing and systematic collection, analysis, as well as interpretation of health data in order to plan, implement and evaluate public health intervention” (Healthpeople 2011). Nurses concerned with epidemiological surveillance programs of the gay community may encounter problems obtaining accurate data from gay couples because most of the data is deemed intrusive of their private lives. This situation is so mainly because other members of society behold gay people with low esteem such that they tend to be confined about their lives. However, nurses should take into account other factors that aggravate the HIV problem in this group such as socioeconomic status, the level of education, and access to public health information concerning HIV trends and preventive measures.
The next step involves nurses investigating HIV and opportunistic disease trends in learning institutions and the employment sector. This step helps nurses to estimate the prevalence of HIV in Montrose society so that they can design how to create awareness in the respective areas. The public health department in Montrose should increase the nursing staff and resources in public hospitals to facilitate HIV tests and to improve the accessibility of treatment.
Concerning outreach, public health nurses of Montrose should seek a grant from the municipality to do community education to the gay population regarding HIV. Gay behavior is considered a risk for the Montrose community since there has been a high prevalence of the disease in that population. In performing outreach to the gay population, nurses should consider various adaptations that are specific to the gay community. Public health nurses should target individuals between the age of 16 to 35 because they are vibrant and liberal regarding sexual behaviors.
Public health nurses may screen students in the learning institutions and workers in public service for HIV. Those that test positive should be enrolled in drugs and counseling services to strengthen their positive living. Nurses should take lead in encouraging HIV victims to seek and adhere to treatment.
The public health nurses should conduct referrals and follow up at the individual level. Referrals and follow-up relate to public health intervention in the sense that, it helps in reaching gay couples. A nurse may get referrals from a bartender where gay people frequent, and arrange home visiting with a gay couple or person. Then, the nurse may develop a mutually agreed-upon plan of intervention. The nurses should inform couples of the risks of contracting HIV posed by gay sexual practices, and the protective measures against it. Other sources of referrals include workmates and students.
Case management follows the identification of people with HIV and AIDS. Nurses can contribute greatly to improving the quality of life of persons with HIV and AIDS. They can help the victims develop a healthy diet program and encourage them to adhere to treatment.
Public health nurses can also contribute towards controlling HIV prevalence through health teaching. This intervention may involve working with gay students at an alternative high school or college program that provides education for overall students on the risks of gay sexual practices, and how they can protect themselves from HIV infection. Public health agencies can organize public forums on gay practices to create awareness to the public and encourage them to treat this group justly in order to relieve their stigma. This perspective will motivate gay people to seek information on the risks involved in the gay practice, and ways of improving their safety.
Public health nurses partner with the mental health center, learning institutions, and faith community to create awareness about the risks of gay sexual practice. Their objective is to transform the community’s idea of gay practice as a right of an individual to the realization of the health risks involved and the protective measures against HIV. 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.
Advocacy is another way through which nurses can help in improving the HIV problem in the Montrose community. By advocating for gay workers, nurses can win over their trust and encourage them to follow protective measures to avoid contracting the scourge. In addition, the nurses will be able to coax gay individuals or couples to give them important information regarding gay sexual practices. Similarly, nurses may help protect HIV-positive workers from intimidation at the workplace and encourage them to seek treatment, and adapt to healthy diet programs.
Nurses may also conduct health promotion campaigns to address HIV and AIDS. The goals of the campaign entail increasing awareness of the risks of gay sexual practice, and improving access to health care services for this community. This perspective is referred to as social marketing. It involves the development of a slogan for nurses to use throughout the campaign.
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.
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). The department of public will want to know if HIV prevalence has gone down after several years. In conjunction, a decline in mental incidence based on the record at Montrose Mental Health Center is a positive indication that the program was successful. Increased utilization of health care services by HIV and AIDs victims as well as gay people supports the effectiveness of the program.
Secondly, the evaluation framework analyzes the design of the program to establish how well it meets the program objectives. This perspective determines whether the program is well suited to supply the data needs of the public health department. For example, due to the sensitivity of the information required by the public health agency, it is very difficult to coax gay couples or individuals to part with the necessary data that will provide an insight into the trend in gay sexual practice. The degree to which Montrose public health agency obtains data reveals the level of success of the program.
Thirdly, the evaluation framework will be evaluated based on the lessons learned from the entire health program (CDC, 2011). These lessons will be based on the objectives of the study. The public health nurses will consider the obstacle to obtaining accurate data from the gay community so that they can design alternative approaches in future intervention programs.
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. Moreover, it sought to underscore 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 the 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.
Community health genogram
This genogram describes the Montrose gay community pattern of sexual behaviors that exposes the population to a high risk of contracting HIV. These sexual behaviors lead to poor mental health as depicted by unstable marriages, STDs, HIV, and consequential poor physical health.
From the genogram above, it is easy to see how the spread of HIV and AIDS is high within the gay community. Just like in the setup of bisexual relationships gay relationships that do not end up in marriage will result in breakups. The rate of marriage in the gay community is minimal resulting in a high risk of the parties involved contracting HIV and AIDS.
Even with the marriages in place, the issue of children is a contributing factor to the increased HIV spread within the community. A gay couple will adopt a child many times if they feel the urge to have one. The children in gay marriages though not in all cases tend to emulate the parent and also end up as part of the gay fraternity.
Teenage is a stage where one has the great urge to find himself and relate with others as well as feel accepted in society. The teenage boys in what I can call the experimental phase tend to embrace being gay. They may be introduced to gays by people their age or older people. Later on, they may either permanently stay gay or decide to switch to members of the opposite sex. The spread of HIV will be experienced as a result of the swap of partners.
HIV can be spread from one person to so many others in a downline sort of system. It is advisable that people who are gay open up about it instead of hiding in a sham of a marriage to prevent the spread of AIDS to multiple partners. The use of condoms, though not 100% safe, should be embraced to reduce the spread of HIV.