HIV burden is most significant among racial and ethnic minority groups and even more pronounced among youths. According to a Center for Disease Control (CDC) report, 21% of the newly-diagnosed HIV cases in 2018 were youths aged between 13 and 24 years (CDC, 2020). Since 44% of HIV-infected young adults are unaware of their status, testing and increasing health awareness among this population is crucial (Koenig et al., 2016). Only 35% of youths between 18 and 24 have had HIV tests (CDC, 2020). Additionally, evidence shows that HIV-diagnosed adolescents are unlikely to seek care or stay in care (Koenig et al., 2016). Without appropriate care, they are likely to transmit the virus to others. Knowing one’s HIV status is crucial not just for the individual but also for their partner and the community.
The target population is Black/African American male youths aged between 18 and 24 years living in Houston, Texas. This populace was selected because studies have demonstrated that they bear the largest HIV burden. According to a 2020 report by the CDC, Texas is the third state with the highest HIV rates (CDC, 2019). African-Americans account for about 44% of the new HIV diagnoses in the United States (Koenig et al., 2016). Among the newly diagnosed, 57% were youths, 63% of whom were gay or bisexual. Koenig et al. (2016) further reveal that the most significant proportions of HIV-infected African Americans were aged 13-24 years old. About 92% of HIV among males is attributed to male-male sexual contact (CDC, 2020). African-American male youths aged between 18 and 24 years are highly affected by HIV.
A significant proportion of this populace was born in economically, socially, and environmentally deprived environments. Due to these conditions, African-Americans’ lifestyle is characterized by poverty, racism, low education levels, environmental exposure, crime, and violence (Edwards & Collins, 2014). Studies show that they are the penurious ethnic group in America, a strong predictor of lacking basic human needs, including healthcare (Edwards & Collins, 2014). Substance abuse, alcohol, and unhealthy risk behaviors are also prevalent issues in the community. Given the vulnerability caused by this population’s lived experiences and socioeconomic environment, it is crucial to improve their health outcomes.
Intervention Overview: Routine Screening or Testing
The CDC and other professional health organizations have issued guidelines requiring routine screening for all adolescents and adults. This recommendation is backed by scientific evidence that shows HIV testing can significantly reduce transmission rates. Additionally, the Affordable Care Act allows all Americans, including youths, to receive HIV testing at no cost. As previously stated, 44% of HIV-infected young adults are unaware of their status (Koenig et al., 2016). Edwards and Collins (2014) recommend making HIV screening a standard of care or routine practice during clinical visits. Regular testing is the only way individuals can know their status and take the steps needed to manage the condition and protect others (Gray et al., 2016). Routine testing as care standard suits this target population since they are less likely to admit to sexual initiation or engaging in risky behaviors. According to Koenig et al. (2016), youths are unlikely to disclose their sexual behaviors and orientation. Furthermore, many adolescents fear discrimination and stigmatization for being gay; hence, they avoid reaching out for prevention and treatment services. Given the increased rate of HIV-infected gay males, routine testing as a standard practice can establish a trusted environment where youths can discuss sex, disclose sex behaviors, and learn how to protect themselves.
While scientific evidence supports routine testing, it is worthwhile mentioning that screening can give an individual a false sense of security. Depending on the test’s specificity, there’s always a risk of a disease being undetected. Additionally, the most sensitive tests require specialized, cost-prohibitive equipment and technicians (CDC, n.d.). Routine testing provides an opportunity for collaborating with other specialists, including counselors, mentors, minority leaders, and community health nurses. This approach can lead to holistic care that can fully address this population’s health needs. Through an interprofessional collaboration, youths can learn that the tests are not an end in themselves but the beginning of healthy lifestyles or choices.
Comparison of Approaches: Health Education
Health education is a multidisciplinary approach involving healthcare providers, community leaders, parents, schools, and public health officials. A recent systematic review found sufficient evidence that group-based risk-reduction interventions such as health education can reduce unhealthy sexual behaviors (Koenig et al., 2016). It involves using a group-based approach to educate the youth on effective strategies for preventing HIV, including heavy sexual behaviors. While screening aims for early detection to initiate treatment and prevent transmissions, health education mainly aims to encourage healthy sexual behaviors to prevent one from contracting the disease in the first place.
The initial HIV/testing outcome is an increase in the number of African American youths who know their HIV status. The criteria to evaluate the outcomes’ achievement can be either population-based or facility-based. They include the number of on-site testing centers in schools and the community (facility-based) and the number of young people using HIV testing services in a given time (population-based). These indicators track the number of youths seeking HIV health services and can be a proxy for health-seeking behaviors. Increasing on-site testing center increases access to the specified health service.
The development and implementation of this intervention plan can take at least one year. The time includes planning time and advocating and negotiating with stakeholders and sourcing for resources. The potential challenges include data integrity issues, miscommunication, and lack of resources and cooperation from stakeholders. It is unknown how long sponsors may take to release the finances, affecting the implementation timeline. The time the public health department and individual schools take to approve and consent to the HIV/testing is also unknown, further affecting the timeline. Data privacy and confidentiality in handling the test data may emerge as an issue.
Screening for HIV infection and diagnostic testing is a crucial step in the HIV Care Continuum. The transmission rate model shows that people living with undiagnosed HIV account for 49% of HIV infections (Koenig et al., 2016). Although the number of people living with undiagnosed HIV has reduced over the years, it still falls short of the national benchmark goal. Researchers have conducted several national surveys to approximate the number of young U.S. adults who have ever received an HIV test. Although research methodologies varied, the results were consistent. The number of young adults who have undergone HIV testing has been decreasing over the years. By the early 2000s, the number of young adults ever tested reduced from 38% to 34% (Van Handel et al., 2016). Between 2000 and 2010, there was no increase in HIV testing among young adults aged 18 to 24 years (Van Handel et al., 2016). During this timeframe, the HIV infection rates among Black males aged 13 to 24 years attained an all-time high record (Koenig et al., 2016). Between 2011 and 2013, the percentage of young adults who had ever been tested remained unchanged among this population (Van Handel et al., 2016). This statistic highlights the significant decrease in the rate of HIV testing among young adults.
Although males account for the most significant proportion of the infected population, women report the highest HIV testing. Van Handel et al. (2016) revealed that 27% of sexually active female students reported ever being tested compared to 17% of males. Unfortunately, over the last few years, HIV testing rates have significantly dropped despite the increasing number of HIV testing programs. The percentage of young adults who have never received HIV testing increased from 34% in 2013 to 44% in 2018 (Van Handel et al., 2016). African-American men who have sex with men (MSM) make up approximately less than one percent of the U.S populace but account for 20-25 percent of all new HIV infections countrywide (Matthews et al., 2016). Findings by these researchers support arguments presented by studies reviewed earlier.
Furthermore, black MSMs typically experience low HIV care retention and linkage rates following their diagnosis. They are unlikely to achieve viral suppression and are incapable (less likely) of conforming to antiretroviral (ART) treatment (Matthews et al., 2016). Studies further demonstrate that HIV incidence among young MSM is significantly high across several nations, and international reports approximate a 4.2 percent HIV prevalence for young gay males below 25 years old (Matthews et al., 2016). MSMs in the U.S account for seventy-two percent of new HIV infections, particularly among young adults aged between thirteen and twenty-four. These statistics categorize them as the only grouping exhibiting a substantial increase in approximated new infections. Black American youths bear the most prominent HIV burden among youthful MSM based in the U.S. From this review, it is clear that HIV testing among young adults who have ever received HIV testing has constantly been reducing in the last decade.
The consequences and risks associated with not receiving HIV testing are clear. Without testing and diagnoses, an individual’s viral load increases. Only 28% of people living with HIV have a suppressed viral load underscoring the importance of routine screening (Moolasart et al., 2018). CDC reported not receiving any CD4 cell count within the last 12 months, signaling that the diagnosed were probably not receiving care for their condition (“HIV in racial and ethnic minority populations,” 2021; Skarbinski et al., 2015). The CDC collects and reports data on CD4 count after every three months (“HIV in racial and ethnic minority populations,” 2021). Having a high viral load increases one’s likelihood of transmitting the disease to others and results in adverse health outcomes. It can also lead to drug resistance and toxicity, leading to treatment failure characterized by immunologic failure and virologic failure (Moolasart et al., 2018). However, testing enables early disease detection and treatment initiation that suppresses the virus and reduces viral transmissions, and HIV/AIDs related deaths. People need to know about their HIV status and personal risks to take the appropriate steps required to protect themselves and the public.
Health Policy That Could Impact Routine Testing
Health policies on HIV prevention priorities can guide the health system on prevention strategies. Recently, the White House formally recognized young adults aged between 13 and 24 years as at-risk populations. Identifying this group as a priority population helps to expedite the population-based health promotion initiatives. Stakeholders can prioritize resource allocation towards programs and interventions targeting the group. In line with the White House’s recommendation, the National HIV/AIDS Strategy (NHAS) developed two national indicators to trace the national progress of the young population’s HIV-related health outcomes (“HIV national strategic plan,” 2021). The indicators include the percentage of gay and bisexual young men who have engaged in risky behaviors and the rate of virally suppressed diagnosed youths.
By recognizing the needs of sexual minorities, the policy enhances safe and inclusive environments for such populations. Without such policies, stigma and discrimination would deter gays and bisexuals from receiving treatment. Another relevant policy is the HealthyPeople Initiative, which aims to increase the proportion of individuals living with HIV and know their status to 90% (U.S Preventive Task Force [USPTF], 2019). The program conducts clinical studies and disseminates data and resources on evidence-based strategies to promote the population’s health outcomes. The information provided by these policies is detailed and comprehensive and can guide community-based response to HIV.
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