Abstract
HIV/AIDS remains one of the primary threats to the well-being of people all over the world. Seeing that there is no cure for the disease, it is crucial to focus on the active promotion of health management strategies and the prevention of the disease. Patient education and enhancement of awareness levels within vulnerable communities must be deemed is a priority. The specified issue is especially topical for the residents of South Florida and especially Miami-Dade, where the lack of awareness combined with social issues such as poverty, inequality, lack of education, etc., has led to the threat of HIV/AIDS epidemics. Although the quality of care for HIV/AIDS patients has improved, creating preventive measures remains a necessity. For this purpose, socio-economic issues such as poverty, poor education levels, inequality, etc., must be addressed.
Introduction
Despite the efforts taken by healthcare services worldwide to prevent the instances of HIV/AIDS contraction by building awareness about the subject matter, HIV/AIDS remains one of the key factors leading to an increase in the death toll worldwide (Surratt, O’Grady, Levi-Minzi, & Kurtz, 2015). According to the latest data provided by HIV.gov and the Federal HIV/AIDS Web Council, there are approximately 36,700,000 people with HIV/AIDS in the world as of 2016 (“The global HIV/AIDS epidemic,” 2017). Furthermore, the number of people that are forced to live without the necessary antiretroviral therapy is becoming increasingly large, thus, causing death rates to rise consistently (“The global HIV/AIDS epidemic,” 2017). Therefore, measures must be taken to handle the situation and address the problem respectively.
Background
Florida is one of the states that have been affected by HIV/AIDS especially greatly. Despite the introduction of the HIV/AIDS Surveillance Program in 2006, the instances of HIV/AIDS contraction among the residents of Florida have been on the increase since 2013 (“HIV/AIDS Surveillance Program Guides Public Health Services,” 2017). Therefore, it is essential to explore the factors that contribute to the aggravation of the situation in Florida and develop an appropriate health management strategy for handling the problem.
There is a thence between being HIV-positive and having AIDS. An HIV-positive patient has the retroactive virus, yet, with the use of appropriate medication, a patient is not affected by it and cannot transmit it to a partner. A person with AIDS, however, is affected by the disease, with their health levels deteriorating. A closer look at the essential factors that define the development of the HIV/AIDS issue among the residents of Florida will reveal that poverty and lack of patient education create the basis for the rapid spread of HIV/AIDS (Surratt et al., 2015). Therefore, the problem will have to be handled on socioeconomic and sociocultural levels so that the rates of HIV contraction and AIDS development could be reduced substantially among the residents of South Florida. With a comprehensive model that will incorporate social media as the means of promoting a connection between patients and nurses, as well as the enhancement of patient education and offering opportunities for the treatment of people from financially challenging backgrounds, a gradual positive change can be expected.
Prescription Drugs
Although there is currently no medication that cures HIV or AIDS, certain drugs can inhibit the development of the disease and increase patients’ longevity extensively. Among FDA-approved antiretroviral drugs, one must mention Nucleoside Reverse Transcriptase Inhibitors (NRTIs) such as abacavir (Ziagen), emtricitabine (Emtriva), and lamivudine (Epivir). Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) are represented by efavirenz (Sustiva), nevirapine (Viramue), and similar medications. Protease inhibitors (PIs), which prevent the virus from making copies of itself, typically include atazanavir (Reyataz), fosamprenavir (Lexiva), etc. Fusion Inhibitors, which do not allow the virus to enter the CD4 cells, are represented mostly by enfuvirtide (Fuzeon). CCR5 antagonists, which affect CCR5 coreceptors and do not allow the virus to enter cells, are included in maraviroc (Selzentry). There are also integrase inhibitors (dolutegravir (Tivicay) and raltegravir (Isentress)), which reduce HIV’s ability to make copies of itself. Cobicistat (Tybost) serves as a pharmacokinetic enhancer, which boosts the efficacy of the medications listed above, whereas combination HIV medicines range from abacavir and lamivudine (Epzicom) to emtricitabine (Odefsey, Complera), to elvitegravir (Stribild) to lopinavir and ritonavir (Kaletra) (National Institute of Health, 2018).
As far as the very goals of antiretroviral therapy are concerned, one must mention that the process is aimed at improving the CD4 T lymphocyte, or CD4, cell count. The decrease of inflammation and mutations that occur at the cell level in a patient’s body during the progress of HIV/AIDs should also be viewed as one of the primary objectives of the treatment process. For this purpose, the plasma HIV RNA must be suppressed successfully. It is desirable to increase the levels of CD4 to at least 700 cells/µL, although 500 cells/µL can also be regarded as a huge step in the right direction (National Institute of Health, 2018).
The very attitude toward the process of HIV/AIDS treatment has changed drastically from an aggressive attack on the virus to using much milder strategies that have significantly less detrimental side effects on patients’ health. Furthermore, the tests of the new era of technology allow for much higher sensitivity than the ones that were used previously. Besides, the possibility of an error has been minimized. Helping detect the problem at the earliest stages of its development, new tests are used to determine the most efficient treatment options and, thus, increase the quality of patients’ lives. Furthermore, the early identification of the problem reduces the threat of denial in patients, thus, allowing them to accept the problem and start dealing with it successfully. It should be borne in mind that, without the medication that cures HIV/AIDS, or a vaccine that could safeguard people from contracting the virus, prompting precaution measures and raising awareness about the subject matter are the primary means of fighting the problem at present. Thus, educating community members about HIV/AIDS must be regarded as the top priority.
As far as personal relationships and contacts with HIV/AIDS patients are concerned, emergency treatment post-exposure (PEP) and pre-exposure prophylaxis (PrEP) must be considered essential. The specified steps imply taking antiretroviral medicine within 72 hours after contact with an HIV/AIDS patient. PrEP, in turn, requires taking tenofovir and emtricitabine to reduce the threat of developing HIV/AIDS (Centers for Disease Control and Prevention, 2017).
Key Factors
South Florida is known for its rather complex history of managing an array of social, economic, financial, and environmental challenges. Among the most recent ones, one must mention offshore drilling that is likely to affect the environment of the area to a considerable degree. The existence of numerous wildlife species and the habitat in which they live will be jeopardized as a result of offshore drilling. Consequently, irreversible changes to the environment are about to occur in the South Florida area.
Social Factors
The fact that a significant amount of the South Florida population has been suffering from financial constraints and is sat the threshold of poverty at present needs to be brought to the attention (Department of Regulatory and Economic Resources, 2013). A recent report shows that in 2013, approximately 250,000 people, or 21% of the residents of South Florida reached the state of poverty (Department of Regulatory and Economic Resources, 2013). With the lack of financial resources, the South Florida population is incapable of receiving the healthcare services of the required high quality, not to mention extraordinarily expensive HIV/AIDS medications (“HIV surveillance,” n.d.). Therefore, social determinants play a significant role in shaping the opportunities for managing the issue of HIV/AIDS contraction and development among the residents of South Florida.
As stressed above, the increasingly high poverty rates of the people living in South Florida can be regarded as the primary factor leading to the increase in HIV/AIDS contraction. However, apart from the economic and financial constraints that prevent the residents of South Florida from learning more about the problem, language and culture barriers deserve to be mentioned. Because of the economic issues faced by the community, Latino citizens of South Florida have very limited access to healthcare services and the information required to prevent the instances of HIV/AIDS contraction (Sheehan et al., 2016). Indeed, the scrutiny of the environment in which the members of Latino communities live in south Florida will reveal that the specified members of the Florida population suffer from increasingly high poverty rate and lack education, particularly, essential literacy skills that could prevent further exposure to the threats of contracting HIV or developing AIDS (“HIV/AIDS Surveillance Program guides public health services,” 2017). Also, the language barrier must be acknowledged as one of the crucial causes of the lack of awareness among South Florida residents concerning the issue of HIV/AIDS (Baumann, Phillips, & Arya, 2015). The connection between the presence of the LGBT community in South Florida should also be drawn since the specified demographics tend to have unprotected sex (Fennie, Trepka, Maddox, Lutfi, & Lieb, 2016). Without the necessary health education and health information resources that would shed light on the importance of using protection, as well as acquiring other habits associated with efficient health management, the residents of South Florida are likely to experience even greater threats of HIV/AIDS epidemics.
Denial
The unwillingness to accept that the problem of HIV/AIDS exists and must be managed is, perhaps, the key cause leading to a rapid increase in the death toll among the citizens of South Florida with HIV/AIDS. One must admit that fear is a very difficult emotion to battle since it paralyzes one’s willingness to struggle for survival. Leading to the development of apathy and similar dangerous attitudes toward the presence of HIV/AIDS, the identified phenomenon causes patients with HIV/AIDS to lose their motivation to fight the disease. Similarly, the fear of people with HIV/AIDS prevents the rest of the South Florida community members from acquiring the relevant information about the subject matter and abandoning harmful myths (Wella, Webber, & Levy, 2017).
The shock and the following unwillingness to accept the problem, however, also reduce the chances for a patient not only to follow the recommendations that local healthcare services will offer but also seek the assistance thereof. The lack of education about HIV/AIDS, the absence of even passing knowledge about the opportunities for efficient treatment and therapy, and the weight of the social stigma that HIV//AIDS patients typically face defining the ability of people living with HIV (PLHIV) to accept the presence of the problem and, therefore, start searching for available healthcare options: “How PLHIV process a positive result can influence their engagement with HIV treatment and care” (Horter et al., 2017, p. 57). In other words, the lack of understanding of HIV-associated threats and treatment options, patients refuse from accepting the care that would help them improve their health status and fight the disease successfully.
Anxiety
Anxiety also complicates the process of tending to the needs of HIV/AIDS patients living in South Florida, as well as the process of educating the rest of the community members about the subject matter. Similar to the previous issue, it is fear that prevents people from exploring the available information resources and learning more about the means of reducing the threat and managing an HIV/AIDS condition. A study by Kamen et al. (2015) shows that fear and anxiety reduce the willingness to accept medications and follow the prescribed treatment strategies among HIV patients.
The development of anxiety and fear is also linked directly to the social stigma with which HIV/AIDS patients are often forced to live. The specified phenomenon often leads to patients withholding information from healthcare providers to avoid social oppression that they are likely to face once their condition becomes the subject of public awareness: “Medically, HIV stigma among African women has been associated with lower rates of disclosure of HIV-positive status to health care providers” (Kamen et al., 2015, p. 69). Therefore, the propensity toward developing anxiety can be viewed as and other crucial obstacles on the way to providing PLHIV and AIDS patients with the required care.
Depression
A depressive attitude toward the management of HIV/AIDS should also be regarded as a significant impediment on the way to improving healthcare service provided to HIV/AIDS patients living in South Florida. The presence of comorbid disorders complicates the process of managing the needs of patients with HIV/AIDS to a considerable extent since additional health issues trigger a massive drop in patient motivation rates (Weiser et al., 2015). Depression, in turn, reduces patients’ motivation to the greatest degree, as a recent study shows:
Patients diagnosed with both HIV/AIDS and MDD (74.43. ± 32.03, 95% Cl: 71.51-77.34) have a statistical significantly (p < 0.0001) lower compliance with AD treatment vs. MDD patients (80.94% ± 29.44, 95% Cl: 80.56-81.33), but the practical significance thereof, is low (Cohen’s d = 0.2255). (Slabbert, Harvey, Brink, & Lubbe, 2015, p. 9)
Therefore, it is essential to prevent instances of depression development in HIV/AIDS patients. The factors contributing to the development of the disorder, in turn, are linked directly to the lack of awareness and negative emotions, primarily, fear, discussed above. Being unable to identify the severity of the problem and at the same time experiencing significant pressure from the rest of the community, people with HIV/AIDS living in South Florida become especially vulnerable to any stress factors and are very prone to developing depressive attitudes. Consequently, the process of diagnosing the issue and providing target demographics with the required medication and therapies becomes overly complicated.
A similar effect is achieved with the enhancement of mistrust toward healthcare services among the members of vulnerable communities. Cahill et al. (2017) report that the presence of strong mistrust toward the representatives of healthcare services is a rather common occurrence among the members of vulnerable communities. The observed phenomenon can be explained by a combination of the lack of patient education in the identified environment and the effects of the social pressure experienced by people with HIV/AIDS: “Medical mistrust among Black MSM is a barrier to HIV voluntary counseling and testing” (Cahill et al., 2017, p. 1352). Medical mistrust is often affected by the strain in the intercultural relationships, as the research reports (Cahill et al., 2017). To be more accurate, the absence of strong ties between healthcare providers and the members of ethnically diverse communities that include the members of African American, Latin American, and other demographics, defines the further rise in the number of HIV/AIDS contractions (Cahill et al., 2017).
Programs
The Quality Management Program (QMP) launched recently in the county is aimed at providing people from socially disadvantaged backgrounds to use the array of healthcare options of which they would have been deprived otherwise. The specified change implies the provision of the necessary medications, particularly, antiretroviral medicine, to the target demographics (“Miami-Dade HIV/AIDS Partnership,” 2016).
Similar efforts are also taken to promote the active acquisition of the relevant knowledge and development of preferable health behaviors among the members of South Florida communities. For instance, the Florida Department of Health in the Miami-Dade community has developed a program recently aiming at reducing the levels of ignorance about the issue of HIV/AIDS among the residents, thus, debunking some of the most dangerous myths and convincing the target demographics to partake in HIV/AIDS tests (“Services,” 2017).
The HIV Continuum Care should also be mentioned among the strategies that allow reducing the impact of HIV/AIDS on patients, as well as improve the quality of the latter’s life. The initiative, which is also often referred to as the HIV treatment cascade, implies defining crucial stages of HIV medical care that patients with HIV/AIDS undergo, from the process of diagnosing to receiving treatment. The specified model allows for not only improving the quality of care by examining the essential step and identifying ways of improving them but also helps establish a better connection between a patient and a healthcare provider. As a result, more detailed feedback can be obtained, and more efficient strategies for managing the needs of people with HIV/AIDS can be offered. Combined with the enhanced therapy and improved medications, the specified approach has contributed to the rise in life expectancy levels among patients with HIV, as well as the overall improvement of the quality of their lives. Compared with the situation that could be observed in the 80s, the current state of HIV/AIDS research allows providing patients with more opportunities. However, the number of comorbidities has also increased, thus, posing a greater threat to HIV/AIDS patients’ well-being (“What is the HIV Care Continuum?” 2017).
Nevertheless, the identified changes are not enough. It is crucial to alter the very perception of the disease among the residents of South Florida and especially the Miami-Dade community. To be more specific, the issue of social stigma will have to be addressed immediately. It is essential to use the available media tools to reach out to the identified communities and educate its residents about the dangers of HIV- and AIDS-related myths. Patients and their family members must be viewed as the key audiences whose needs will have to be addressed first. Describing the opportunities for an improvement in health outcomes and the changes to reduce the effects of HIV/AIDS development by taking antiretroviral medications, healthcare practitioners will be able to reduce the death toll among the members of South Florida residents with HIV/AIDS (Heck, 2015).
It should be noted, though, that the process of handling the negative attitudes of the community members is going to be comparatively long and will require a significant amount of patients. A recent study shows that several states will have to be passed to facilitate the successful management of the issue and the reinforcement of a positive attitude toward people with HIV/AIDS; particularly, a heavy emphasis must be placed on inviting community members to participate in social activities that will contribute to information exchange and knowledge sharing (Martinez et al., 2016). Exploring the issue of the systemic oppression of Latino men with HIV/AIDS, the author of the study stresses the need to encourage an open dialogue:
The adaptation process includes five steps: 1) engaging community stakeholders; 2) capturing the lived experiences of Latino male couples; 3) identifying intervention priorities; 4) integrating the original intervention’s social cognitive theory into a relationship-oriented, ecological framework for Latino male couples; and 5) adapting intervention activities and materials. (Martinez et al., 2016, p. 3)
For this purpose, however, one will need to develop an approach based on the principles of multicultural communication. The National Strategy Against HIV/AIDS for the USA, which implies addressing inequalities in the provision of the required services and medications, partially touches upon the subject, yet further measures must be taken to handle the crisis (“What is the National HIV/AIDS strategy?” 2010). As stressed above, the residents of the Miami-Dade community and South Florida, in general, can be described as outstandingly diverse. For instance, the community includes the representatives of Latin American, African American, and Asian American cultures, to name just a few (Martinez et al., 2016). Therefore, designing the framework for communication that could appeal to every single member of the specified demographics will need to be created.
Finally, the issue of program availability needs to be discussed as one of the sources of concern. At present, there are several programs aimed at assisting people with HIV/AIDS, Ryan White Program is one of the best-known frameworks for assisting vulnerable communities. According to the official definition, the program was designed specifically for meeting the needs of people with HIV/AIDS and without insurance, or with the one that does not provide sufficient coverage of the associated expenses (“Ryan White Program,” n.d.). On the surface, the specified approach can be deemed as an important step in the right direction as far as assisting people with HIV/AIDS is concerned. However, a closer look at the framework will show that the program lacks the elements that could allow its participants to appeal to the members of diverse communities in Florida. Therefore, the program aimed at addressing the problem of HIV/AIDS in the context of the South Florida community will have to incorporate a multicultural framework for communicating with the target population. As a result, a better understanding of the needs of the local population will become a possibility.
Furthermore, the introduction of a framework for a cross-cultural dialogue will build the foundation for eradicating some of the most dangerous myths about HIV/AIDS that persist in the modern South Florida community and poisons the relationships between its members with and without the HIV/AIDS problem. To be more accurate, the tools for enhancing the communication between HIV/AIDS patient and nurses will be introduced, and a strategy for encouraging the residents of Miami-Dade and South Florida, in general, to encourage further knowledge acquisition and the development of healthy habits for preventing and managing HIV/AIDS will be designed successfully. It is expected that, by appealing to the culture-specific characteristics of the target population, one will be able to start a dialogue about the stigma of HIV/AIDS. As a result, the effects thereof on the relationships between HIV/AIDS patients and the rest of the community members will be mitigated to a considerable extent. The specified outcome is bound to lead to an impressive drop in the levels of depression and anxiety among HIV/AIDS patients living in the Miami-Dade community.
The AIDS Drug Assistance Program, or ADAP, is another framework designed to assist people with HIV/AIDS. In contrast to the Ryan White approach, the proposed framework focuses solely on the delivery of antiretroviral drugs to the patients that come from low-income backgrounds and, therefore, do not have an opportunity to purchase the necessary resources for treatment and disease management on their own. Although the specified program is much more direct than the Ryan White one and, therefore, provides immediate assistance to the target population, it also has its flaws, the absence of focus on communication is the key one. Although delivering the required medications to the members of vulnerable communities is essential, one will also have to convince the target demographics that they need the help of healthcare providers, as well as the support of nurses, who will encourage them to acquire the necessary knowledge and skills (“ADAP,” 2017).
Conclusion
The introduction of a multicultural program that could help improve the current levels of awareness among the residents of South Florida, thus, must be viewed as a goal to be completed urgently. Building awareness must involve providing relevant information to not only patients but also the rest of the community members. As a result, a range of myths will be debunked, and the systemic oppression and social ostracism experienced by people with HIV/AIDS in Miami-Dade and other communities of South Florida will be eradicated from society. The principles of social justice based on acceptance and support must be deployed. As soon as the members of South Florida, in general, and the residents of Miami-Dade, in particular, start providing support for HIV/AIDS patients, significant improvement in the management of the problem will be expected.
Particularly, social prejudices against people with HIV/AIDS will be subverted successfully, and HIV/AIDS patients will no longer be ostracized by the rest of the community. Furthermore, a friendlier social environment will contribute to the enhancement of the learning process among patients, their families, nurses, and the rest of the community members. As a result, the families of HIV/AIDS patients will learn to provide the necessary support, the people living in South Florida will learn to accept patients with HIV/AIDS, and nurses will build cross-cultural communication strategies aimed at obtaining the necessary information and encouraging an intercultural dialogue with patients. Thus, the management of HIV/AIDS patients in South Florida will become more efficient, and the opportunities for positive tendencies in the management of the disease will be discovered.
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