Introduction
HIV was discovered in the 1980s and has since spread all over the world. It has been established that the disease is more prevalent in women and people of low social standing. In North Carolina, the distribution of the infected people is skewed towards the minority populations such as African Americans (AA) and the Hispanic population of low socioeconomic status. AA Women in this state have, therefore, a higher transmission rate and are more affected than their counterparts in the population.
This study aims at showing how strategies such as providing education, emotional support, resource outlets, and counseling can be used to help in lowering HIV infection rates. The paper will focus on the population of African American female minorities in North Carolina who are affected by HIV. It will in particular focus on Burke and Caldwell Counties.
Purpose
The purpose of the studies was to establish the demographic dynamics of HIV, treatment interventions and adherence rates, risky behaviors, possible interventions, and try to relate these factors to the contraction rates and prevalence of HIV. The research on the demographics focused on how race and socioeconomic factors affect the prevalence rates of HIV. This then gave insights on what kind of intervention was appropriate for these groups.
The treatment and adherence rates were also examined in some of the cases and analyses were done on their adherence behaviors. Some of the studies looked at the risky behaviors associated with HIV and some of their causes. Further, there were studies to find out what kind of interventions could be applied in the areas under study to empower the vulnerable groups on how to avoid infection and how to live positively for those infected already.
Integrated Review of studies
The study that I read gave insights into the availability of resources and the disproportionate contraction rates of minorities and AA females living with HIV. The purpose of the study was to identify the risk factors and behaviors associated with HIV.
Major sample characteristics
The sample areas covered the whole of the United States with special attention to North Carolina and its’ rural areas. The minority groups under observation included AA, Latinos, and Mexicans. The socio-economic status of those sampled was also considered because it was believed that prevalence was higher among people with low socioeconomic statuses.
The HIV pandemic has highly affected the African American population in North Carolina. This situation has largely been associated with the low social-economic status of the female population in the rural areas of the state. Reports indicate that about 26,168 cases diagnosed with human immunodeficiency virus (HIV) are still living (Center for Disease Control and Prevention, 2013). This figure is one of the highest in the United States. The rate of new infections is also high. The report continues to state that in the year 2011 alone, there were 1,563 newly diagnosed cases of women living with HIV. Although all ethnic groups in the state are affected by the problem, the group that beats the rest in the prevalence and the rate of a new infection is the African American group (Healthy People, 2013).
One of the factors affecting adherence to treatment and the outcome of the treatment of HIV is the socio-economic status of the people living with the condition. Reports on the income for the people in the state of North Carolina showed that the average income in Burke County in 2010 was $37, 225 which was well below the national level (Census 2010 Data: Population, 2013). The average income in Caldwell County was $45,151 for the same year which was significantly higher than Burke County and closer to the national average (Caldwell County Quickfacts from the US Census Bureau, 2013).
In the year 2011, 42 people were living with HIV in Burke County compared to 91 people in Caldwell County who represented a prevalence rate of 1.2% (Caldwell County Quickfacts from the US Census Bureau, 2013). Burke county was ranked 90th with a rate of 1.1 (Census 2010 Data: Population, 2013). In the US in general, African Americans represent 68% of all the cases diagnosed with HIV (Healthy People, 2013). These cases were reported at a rate of 62.8 per 100.
Search Strategies
While completing this review, I used a variety of search strategies. I used keywords like HIV, mental illness, and African American to gather my information and used CINAL search to find articles. In addition, I used the Center for Disease Control and Healthy people 2020 to gather current information.
According to Cook, McElwain, and Bradley-Springer (2010, p. 23), people living with HIV are involved in behaviors that placed the general population at risk of contracting the infection. This argument shows that more education is needed to prevent the spread of the infection in the population. The rural areas present a unique challenge in hindering the spread of the infection. Although there are resources available in these areas to help contain the situation, infection rates still soar.
Research Design
Research designs used were: Randomized control design, quantitative, qualitative, cross-section, and non-blinded randomized control trial.
The first research design used a quantitative design with questionnaires while the second used a cross-sectional study to identify drug discontinuation in those infected with HIV. A special group of the population is affected by the conditions existing in the rural areas. Although there has been a continued decline in the number of women living with HIV, there is a need to help them in the social sectors to ensure that the transmission rate is reduced (Phillips et al., 2011).
There are many barriers in these areas that hinder the adherence to the measures set in place to ensure reduced transmission and improved quality of life. These include financial, mental, stigma, family, lifestyle, abuse, education, and transportation issues (Cook et al., 2010). All future attempts to tackle the problem must be focused on understanding the barriers of noncompliance existing in the population. Developing programs to help minority women with treatment plans will further reduce the number of cases reported and reduce the burden of cost to society. Center for Disease Control and Prevention (2013) calculated that 16.6 billion dollars were spent on newly diagnosed HIV cases.
There are many programs to assist people living with HIV such as the ‘get real get tested program’ and other prevention programs. One purpose of this study is to get funding to develop programs in rural areas to decrease the number of new cases of HIV among African American women. A recent study found these people lacked insurance cover, complained of premium increases and the soaring price of ‘over-the-counter drugs above the reach of the affected women. These and more factors, according to Bingham (2009), play a role in the increase of HIV.
Several studies have shown a relationship between resource allocation and the needs of the people living with HIV (Tsai et al., 2013, p. 119). One such study by Rountree et al. (2011) aimed at establishing whether some races and ethnicities test more for HIV than others. Worth noting in this study is the high testing rate observed in the African American race, which may be a contributing factor to the high number of reported incidences (Lasry et al., 2011, p. 120).
Murri et al. (2009, p. 45) further studied the factors that influence the adherence to medication for the infected people. The results indicated that women have more factors affecting their adherence compared to their male counterparts.
The researcher in his study of barriers considered the areas of residence and levels of income. Some of the factors established to influence how these women seek medical help included: the long-distance traveled to get care, lack of housing, lack of HIV-trained medical practitioners, lack of mental health services, and lack of substance abuse treatment (Philips et al., 2011, p. 28). Rountree et al. (2011) claim that this situation affects the economy negatively and leads to heavy expenditures in the health sector.
Their study was a pilot conducted in domestic violence shelters. They used a survey as their sampling and most of the victims were African American women. In the research, Rountree et al. (2011) observed that women had an increased risk of infection. The study emphasized the provision of information to women to help keep them safe and lower the risk of infection. It also provided an insight into the absence of resources in the rural areas where it was conducted.
Murri et al. (2009) found major adherence problems in the study population. Another finding was that people who discontinued drugs had a higher CD4 cell count, higher HIV RNA, and was less likely to take non-nucleoside reverse transcriptase inhibitors (Murri et al., 2009). This observation was because the people who had their medication discontinued opted for a switch that helped them adhere to a medication of their own choice. This case demonstrates that the freedom of decision-making in treatment for these patients is important (Whiters et al., 2010, p.110).
Major components of interventions
Education is one of the major components in the prevention of the spread of HIV. According to studies done on the social status of the ethnicities in the state of North Carolina, the levels of education are lowest among the ethnic minorities such as the Hispanics and the AA (Rountree et al., 2011). This was an indication that the AA women were unable to utilize their resources because they lacked the know-how.
The level of education can be used in several ways to improve the lives of persons living with HIV in North Carolina. One way would be to provide education to the black population among the infected. Rountree et al. (2011) established that the prevalence of the disease is indirectly proportional to the level of education attained by the individuals. North Carolina ranks ninth in the rate of infection and the number of people living with the condition.
This finding represents a significant population of the US. Out of the people affected by the pandemic, black Americans make up 66% half of which are women. This figure is, however, not representative as the number of women infected is far beyond half of the reported number of black Americans. An explanation for the differences in prevalence between the sexes in the same race includes biological differences, use of drugs, and the relative inability of women to negotiate for safe sexual practices (Cook et al., 2010).
Theoretical frameworks
Campaigns to promote education should be included in the strategies that organizations and the government of the state of North Carolina employ to reduce the prevalence of the disease. It has been found that the effects of education on the prevalence of HIV are profound and the adoption of health and sexual education in the curriculum especially in rural schools reduced the HIV infection rate. This can effectively be addressed by educating the people who are infected and their counterparts who are not. The sexual partners of the infected black American women are at a high risk of contracting the condition.
Education would ensure that they protect themselves. Another observation made in this population of people living with the condition is that, despite the provision of resources to curb the condition, the women are not taught the benefits of the medication, hence the non-compliance.
Most of the black American women living in North Carolina and infected with HIV are single mothers with no stable sources of income. This has led to some of them engaging in illegal activities such as prostitution to enable them to provide for their families.
Outcome measures
An important factor in the spread of HIV infection and the outcome for the infected population is the emotional support provided to the affected people. In North Carolina, several agencies and organizations are committed to providing emotional support to the people living with the infection (Cook et al., 2010). However, a survey on the emotional support of AA women revealed that they are not able to access the services offered by these organizations especially when living in rural areas.
One recognized source of emotional support for patients is their families, which are the first people of contact. A high number of AA women living with HIV in North Carolina have no families or are single parents; this means that they receive inadequate emotional support. The organizations providing support should therefore facilitate the creation of social groups for these disadvantaged women. These therapeutic groups could also help in reducing HIV-related stigma (Whiters et al., 2010). In most of the research done on the factors affecting the condition, stigma is recognized as having some of the most negative effects. To deal with stigma, the government and other organizations offering services to these patients have to encourage the formation of social groups for the infected so that they can share their experiences and help reduce stigma.
Counseling is another method that could be used in combating the prevalence and the high rate of transmission of HIV among women in North Carolina (Mobility and Mortality Weekly Report, 2005). Studies done on the effects of counseling indicate that the rate of transmission is reduced by increasing the number of people who are counseled. Some of the things that individuals need to be counseled about include the benefits of using their medication, how to live positively, and the measures they can take to prevent infection of their partners if not infected.
Major findings
The rates of infection are higher in the population that does not counsel its patients. North Carolina should ensure that the African American women in the rural areas living with the disease are adequately counseled. Counseling should also be done by use of interactions with their families and friends. They should also be encouraged to live a complete and fulfilled life and be made to understand that getting the infection is not the end of life. This information would go a long way in ensuring that the infection rates are reduced and that the infected women live a healthy life.
Other Factors/Unexpected Findings
There were no unexpected findings identified in all studies.
Strengths and Weaknesses
The studies had both strengths and weaknesses. Some of the strengths included: the use of different parameters for some sets of the population to get a clearer result. This was observed when African Americans under review were also classed according to their socio-economic status. Strength was the use of valid data sources like information from the CDC and the American census bureau.
The weaknesses included low response in some areas, limited sample sizes, and inadequately defined sample sizes. The samples were also limited as they focused on just a few ethnic and racial groups.
Discussion
The studies identified many barriers to prevent the spread of HIV. They also identified social, emotional, mental, and physical barriers interfering with positive strategies for preventing the spread of HIV. According to Philips et al. (2011), people with mental illnesses are at risk of HIV. The studies also identified the risky behaviors that contribute to HIV contraction as lack of good judgment, awareness, and immorality.
Conclusion
In conclusion, the AA population was found to be disproportionately affected by the HIV pandemic in the US; this fact was also apparent in the state of North Carolina. Although the disease has affected a considerable portion of the population in this state, it was apparent that the better portion of the infected population consists of AA women. The research articles established that according to the Center for Disease Control and Prevention (2013), the situation was large because of the low social-economic status of the female population in the rural areas of the state.
There were two types of designed studies under investigation. The studies were cross-sectional and randomized samples. Some of the factors that the researchers considered to be the cause of the high infection rate among AA women in these areas were also discussed. The research articles revealed that according to Cook et al. (2010) and Phillips et al. (2011), some of the major barriers to reducing the pandemic include communication, education, and mental illness.
As revealed in the paper, it was proven that women in North Carolina state do not have access to adequate education, which is a tool that could enable them to understand how to deal with the HIV pandemic. In the articles, according to Cook et al. (2010, p. 23), people living with HIV are involved in behaviors that place the general population at risk of contracting the infection. This argument shows that more education is needed to prevent the spread of the infection in the population.
Moreover, it was established that women lack counseling and emotional support, hence their worsening health. The studies, therefore, sought to show how employing these strategies in the state of North Carolina would help to change the situation. The study successfully demonstrated how the implementation of these strategies could facilitate progress in addressing the pandemic in the state of North Carolina.
Reference List
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Caldwell County Quickfacts from the US Census Bureau. (2013). Quickfacts. Web.
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Murri, R., Guaraldi, G., Lupoli, P., Crisafulli, R., Marcotullio, S., von Schloesser, F., & Wu, W. (2009). Rate and predictors of self-chosen drug discontinuations in highly active antiretroviral therapy-treated HIV-positive individuals. AIDS Patient Care & Stds, 23(1), 35-39.
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Rountree, A., Goldbach, J., Bent-Goodley, T., & Bagwell, M. (2011). HIV/AIDS knowledge and prevention programming in domestic violence shelters: How are we doing?. Journal Of HIV/AIDS & Social Services, 10(1), 42-54.
Tsai, C., Karasic, H., Hammer, P., Charlebois, D., Ragland, K., Moss, R., &… Bangsberg, R. (2013). Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: A randomized controlled trial. American Journal of Public Health, 103(2), 308-315.
Whiters, L., Santibanez, S., Dennison, D., & Clark, H. (2010). A case study in collaborating with Atlanta-based African-American churches: A promising means for Reaching Inner-City Substance Users with Rapid HIV Testing. Journal Of Evidence-Based Social Work, 7(1/2), 103-114.