Abstract

In the modern world, reproductive health and sexually related behavior of young people determine the future of our society. Sexuality is valuable for people disregarding of their age, gender, or social status, and yet the growth of social activity of the young people during the past several decades, accompanied by the lack of knowledge when it comes to the question of preventing STD and HIV, makes the problem topical. Increased incidents and prevalence of HIV have been documented in the United States. Risk factors of HIV include; sexual intercourse, both vaginal and anal; substance abuse (injection drug use), among others. The number of diagnosed individuals varies from state to state with some states like Maryland reporting the highest number of cases. Prevention programs have been developed to reduce the prevalence of the virus among the people. This paper provides an overview of HIV and its prevention in Maryland. It provides demographic and epidemiologic data regarding risk factors, mortality rates and disparities that provide evidence on the rate of incidence and prevalence of the issue. Additionally, it provides a social justice rational justification of the HIV prevention programs Maryland has embraced.
GOAL
Prevent new cases of human immunodeficiency virus (HIV) infection in Baltimore, Maryland.
OBJECTIVES
1. Reduce the number of new HIV infections among adolescents and young adults by 40% by December 2020.
2. Increase the proportion of persons living with HIV who know their status by 50% by December 2020.
3. Increase the proportion of sexually active persons who use condoms by 75% by December 2020.

HIV Prevention in Baltimore, Maryland

HIV is a worldwide pandemic that has claimed many lives over the years. There has been significant progress in the prevention and management of the disease; however, this is not to mean that there are no new infections. Thus it is essential to focus on the prevention and particularly to the one of the most vulnerable group of people which is the youth. Engaging in sexual relationships is widespread among young people and old alike; however, the possibility of young individuals contracting HIV is significantly higher because they also participate in other activities which increase their risk of contracting the disease. Engaging in drug and alcohol abuse may lead one to make an uninformed decision which places them at a higher risk of getting HIV. Hence, HIV prevention is necessary for the progress and future of a nation.

The goals of the HIV prevention program in Baltimore, Maryland is to prevent new cases of human immunodeficiency virus infection in Baltimore, Maryland. To meet the stated goal, the program will address the following objectives:  1. Reduce the number of new HIV infections among adolescents and young adults by 40% by December 2020.
2. Increase the proportion of persons living with HIV who know their status by 50% by December 2020. 3. Increase the proportion of sexually active persons who use condoms by 75% by December 2020.

The HIV prevention program will employ the MAP-IT framework to guide the planning and evaluation of the program in the described community. The health department of Baltimore is one of the key stakeholders to be mobilized by the program, people living with HIV aids in the community are also needed as well as other people who are not infected. Certain risk factors increase the rate of HIV infection in Baltimore. People falling within the risky categories will also need to be mobilized since they are fundamental in preventing the spread of the disease.

The HIV pandemic is a persistent menace in Baltimore with the city among the leading metropolitan regions with a high rate of HIV infection. The rate of HIV infections is particularly high among men who have sex with men MSM, and at the same time, viral suppression within this group of people is very low (Schwartz et al., 2017). Therefore, the risk of infection increases given that viral suppression is significantly very low. Ensuring that the MSM population is directly involved in the program will enable the program to make significant strides in promoting HIV prevention.

A demographic factor which informs about HIV Prevalence rate in Baltimore is race. African-Americans continue to be disproportionately impacted by HIV infections. They, however, form the largest population in Baltimore so it is statistically expected that a higher percentage of people living in the city will be African-Americans. Nevertheless, despite the high prevalence rate of           HIV among people in this group, the number of new infections is slightly decreasing while that of Hispanic and white is steadily rising. As such, when mobilizing relevant groups, it is essential to include African Americans as they are the most affected population.

The age group between the age of 15 and 29 is particularly needy because the rise in HIV infection is observed to be greatest within this age bracket with 33% of new diagnoses in Baltimore belonging to this age group (Buchbinder, & Liu, 2018). Hence there is a need to consider young people of this age when implementing the program.

To achieve the three objectives, a number of activities which are aligned with the objectives will be implemented. The first objective seeks to reduce HIV infection among adolescents and adults. The activities leading to achieving this objective deal with behavior modification. Young adults and teenagers often engage in sexual intercourse with many partners, and they often do not use condoms, which explains the high rate of infection within this age group (Wong et al., 2017). Other than irresponsible sexual activity, adolescents and young adults engage in other behaviors which increase the risk factors for HIV infection. Having sex for drugs, drug injection and males having sex with males are among the behaviors leading to increased infections. Health education programs focusing on behavior change is a significant activity that can help achieve the first objective. Education should emphasize the proper use of condoms and the benefits of using them. Teaching about abstinence is another important aspect of the activity as it is one of the surest ways of preventing sexual transmission of disease. In the US, 25% percent of HIV positive people contracted the infection in their teenage years (Wang et al., 2015). Thus, promoting the concept of abstinence is crucial as it zeros out the possibility of getting HIV through sexual intercourse.

The second objective directs that the number of people who get tested for HIV needs to increase so that the proportion of positive people who know their status may increase by 2020. One of the activities that lead to the accomplishment of the objective is an increase in the number of testing and HIV awareness programs. Additionally, making HIV testing part of healthcare routine will see that many people get tested.

The theory of reasoned behavior directs the activities leading to the achievement of the third objective. The theory forecasts intentional behavior because actions can be planned and deliberate, it positions that intention is what drives a person to take specific actions, and the intention is based on the attitude of the person towards the action (Tuck & Riley, 2017). The theory is applied in learning the attitude of sexually active people towards using condoms. The information gained is used to predict behavior towards condom used and therefore used to design appropriate interventions to encourage condom use among sexually active adults.

Health organizations working in Baltimore will immensely contribute to the success of the program as it covers a wide geographical area. The Maryland Health Care Commission is one of the fundamental organization to be involved in the program. It is mandated with the duty of collecting, reporting and releasing health data; therefore it is vital for providing statistics about the present state of HIV in Baltimore. Collaboration with healthcare facilities within Baltimore is also essential as HIV testing treatment, and record of new infections is often done in healthcare facilities.

The development of every objective will be tracked to ensure that all the activities aim at achieving the goal of the HIV prevention program. An evaluation of every activity specific to each objective will inform if the project is headed in the right direction. The first objective is primarily attained through educational methods, an assessment of the teaching strategies and their effectiveness will inform if they have an impact on the intended population. As the activity is a continuous process, the objective will be considered to be achieved when HIV infections among young adults and adolescents are reduced by at least 40%.

An assessment of the second objective will be done by evaluating the number of HIV testing programs and the number of people who have tested. An increment of 50 percent in those who know their HIV status and are also positive will be estimated by identifying an increase in the number of those who have been tested. If the value is statistically significant than the previous number of people tested then, the second objective is considered attained. Objective number three is attained by increasing the number of people using condoms 75%; at this rate many sexually active adults will be using protection which is key in preventing the spread of HIV.

Conclusion

HIV prevention is a significant activity which is achievable through different strategies. Among the objectives identified for preventing HIV infection is reducing the number of young adults and adolescents who contract the disease since they are among the groups of people at high risk. Increasing the number of HIV positive people who know their status is also essential in preventing HIV. By knowing one’s status, a positive person can prevent the spread of the disease and also inform their partner and protect them from infection. HIV prevention program also works by increasing the number of sexually active people who use condoms. The achievement of these objectives is done through various activities which are distinct for each objective. Educational programs which enlighten the public about HIV prevention measures are among the activities which promote the goal of the program. Collaborating with other departments and health care facilities also drive the success of the program because the geographical scope requires the involvement of many different parties.

References

Wong, V. J., Murray, K. R., Phelps, B. R., Vermund, S. H., & McCarraher, D. R. (2017). Adolescents, young people, and the 90–90–90 goals: a call to improve HIV testing and linkage to treatment. AIDS (London, England), 31(Suppl 3), S191.

Wang, H., Wolock, T. M., Carter, A., Nguyen, G., Kyu, H. H., Gakidou, E., … & Coates, M. M. (2016). Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. The lancet HIV, 3(8), e361-e387.

Tuck, M., & Riley, D. (2017). The theory of reasoned action: A decision theory of crime. In The reasoning criminal (pp. 156-169). Routledge.

Buchbinder, S. P., & Liu, A. Y. (2018). CROI 2018: Epidemic trends and advances in HIV prevention. Topics in antiviral medicine, 26(1), 1.