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The implementation of the intervention
The proposed intervention was to introduce community-wide education programs to raise awareness of the people regarding the needs of HIV/AIDS patients and to dispel the myths that lead to stigmatization of the disease. This practice is among the main recommendations of the UNAIDS (2014), and it is anticipated that the intervention would promote greater awareness and reduce the fear of HIV transmission, which is among the lead causes of AIDS stigmatization (UNAIDS, 2014).
The first step of the intervention was to compose and distribute leaflets containing proven medical information on HIV transmission that opposes the myths present in the community (for instance, that HIV is highly contagious and that people should avoid contact with AIDS patients to reduce the risk of transmission). However, there were certain barriers to distribution of the leaflets. For example, certain institutions that were approached and asked to distribute the leaflets, such as local churches and community centers, refused to participate. Thus, further adjustments to the design will need to be made to proceed with the intervention.
The leaflets were only distributed in one facility, which is a local medical center that agreed to place the leaflets in one of its reception areas. This way of distribution was not effective enough as people did not see the leaflets or did not want to read them. Thus, the results of the intervention so far are very limited. I assume that the level of stigmatization of AIDS patients from the people who read the leaflets has decreased significantly; however, the primary intervention scheme lacked the detailed assessment plan regarding the stigmatization. The outcomes that were supposed to be measured, such as health outcomes, on the other hand, are long-term results and will take a lot longer to become prominent.
Overall, in order to increase the efficiency of the intervention, several changes need to be made. First, distribution channels have to be evaluated and new facilities should be approached regarding the distribution of leaflets. Secondly, in order to analyze the effectiveness of the intervention in decreasing the stigma, a survey of the readers should be made to find out if the information had any effect on their perception and treatment of the AIDS patients. With these modifications, the intervention will most likely become effective in decreasing the stigma across the community.
The risk assessment and the intervention for the aggregate
The intervention was focused on the AIDS patients that face severe stigma in the community. Studies suggest that the stigmatization of AIDS patients is a widespread problem both in the United States and around the world. People who have AIDS are frequently perceived as individuals with loose morals, who have obtained the disease through unsafe sexual practices, drug use, and other promiscuous behaviors.
For example, in a study by Dahlui et al. (2015), stigmatization and discrimination against PLWHA is prominent in all countries but varies greatly across the population. For instance, the study showed that young people, men, married couples, and people with low levels of education are more likely to discriminate against AIDS or HIV patients (Dahlui et al., 2015). Only about 70% of the respondents confirmed that they would care for a relative with HIV or AIDS (Dahlui et al., 2015). On the other hand, people with higher income and those who received a formal education were less likely to have the stigma on PLWHA (Dahlui et al., 2015).
In the United States, stigmatization is nonetheless present, and it affects all aspects of lives of HIV and AIDS patients. Even in medical care facilities, workers may have stigma, which affects the quality of treatment: for instance, one in four medical workers would test a patient for HIV without obtaining his or her consent, and over 40% of medical care staff agree that people living with HIV do not care if they infect other people (Nyblade et al., 2013). The project showed that stigmatization has a variety of adverse effects on HIV/AIDS patients; furthermore, it presents a threat to the community, as it leads to non-disclosure of status to partners and family members and impairs treatment adherence (Katz et al., 2013).
The Aggregate Description
The aggregate for this project consisted of five HIV-positive patients who reported facing stigma and discrimination in their community. Four out of five participants were young males, aged between 23 and 29. The fifth participant was a 35-year-old woman. All of the members of the group have been diagnosed with HIV within 2 to 4 years ago and reported experiencing severe stigma and discrimination from those informed about their status.
All of the subjects are unsure as to where they obtained HIV from, but presume that it was due to unsafe sex practices. The fact that the patients are not aware of when or how they got HIV means that they could have spread the virus further across the community without knowing it. None of the subjects thought about having HIV until they participated in routine testing, which is currently promoted all over the country to improve peoples awareness of their HIV status, thus preventing unintended transmission to partners or other people.
Four of the subjects proceeded with antiretroviral therapy (ART) after they discovered the diagnosis. One of the patients, however, did not, as he wanted to conceal his status from people surrounding him. A 23-year-old male felt that attending ART would mean that more people will find out his status and thus refused the treatment.
Strengths and Weaknesses
The main strength of the aggregate was the patients desire to adhere to ART and share the information about their status with sexual partners. Four of the five subjects reported receiving ART, and all of the subjects stated that they had disclosed the information about their status to their partners. Another strength was the participants willingness to learn more about preventing transmission and adhere to safe sex practices to limit the risks of spreading the virus further.
The participants who were in a mixed-status relationship confirmed that they informed the partner about their status and that their partners completed pre-exposure prophylaxis (PrEP) therapy before engaging in intimate behaviors. The use of condoms was consistent throughout the group, even for safer sexual practices, such as oral sex. Four of the five patients also reported undergoing regular screening for other STDs and encouraging their partners to do the same.
However, certain weaknesses could still be observed in the aggregate. For instance, three of the patients did not disclose their HIV status to family members, friends, and co-workers due to the fear of discrimination and stigmatization. The risk of transmitting HIV through casual contact is very low; however, support from friends and family could help patients to overcome depression, low self-esteem, discrimination, and stigma associated with their status. For instance, a study by Rao et al. (2012) proved that perceived social support was associated with less stigma, less depressive symptomatology, and better quality of life (p. 481).
Risk Assessment and Diagnoses
The subjects agreed that they perceived stigmatization as one of the main threats to their quality of life and mental health. Indeed, studies suggest that social stigma can have a lot of negative effects on people with HIV-positive status, as well as on AIDS patients. Herek, Saha, and Burak (2013) state that both societal stigma (felt stigma) and negative feelings toward oneself as a member of a stigmatized group (self-stigma) have negative consequences for people living with HIV/AIDS, such as higher rates of depression and anxiety. In addition, other studies point to low self-esteem as a result of stigma, which impaired the persons ability to cope with the diagnosis and live a fulfilling life (Varni, Miller, McCuin, & Solomon, 2012). Social alienation is another risk faced by HIV and AIDS patients in the contemporary society.
According to Cahill and Valadez (2013), this can lead to them receiving fewer social support services and experience more rejection, both in casual and professional encounters. Fear of contagion and perceived incompetence in dealing with HIV-positive people were also among the main factors influencing the employers in their decisions, which leads to high rates of unemployment among HIV and AIDS patients (Liu, Canada, Shi, & Corrigan, 2012).
The medical health of the aggregate may also be impaired due to the stigma present among the health workers of the community. For example, only half of medical care institutions studied by Nyblade et al. (2013) had policies in place to prevent discrimination against PLWHA. Almost 16% of health workers questioned felt that people with HIV should feel ashamed of their status (Nyblade et al., 2013).
About a third of respondents reported seeing a healthcare worker talking badly about HIV patients and using extra precautions, such as double gloves (Nyblade et al., 2013). Over half of the medical personnel felt hesitant to work with HIV-positive people, and 20% reported witnessing a medical worker in the facility to provide poorer quality of care to people living with HIV than to other patients (Nyblade et al., 2013). A combination of these factors poses a threat to the mental and physical health of the aggregate.
Therefore, the primary diagnosis for the aggregate is impaired social interaction. The subjects also show risk for ineffective healthcare maintenance due to the possible obstacles to obtaining qualified care. Moreover, there is a risk for disturbed personal identity due to self-stigma. All patients show readiness for enhanced comfort and communication.
Care Plan for the Aggregate
As of now, none of the subjects present significant medical concerns that are in need of treatment. However, given that one of the patients did not proceed with his ART treatment, the first step of the plan would be to educate him on the opportunities for anonymous medical services and to encourage him to visit the medical institution that provides ART and has solid confidentiality and non-discrimination policies in place.
The rest of the concerns, however, have to be mediated through decreasing stigma evident in the community and addressing the mental health of the subjects. For instance, it would be useful to refer all subjects to a qualified therapist, who would be able to provide advice on coping with the diagnosis and living a fulfilling life. Another important issue is the clear lack of social support. The therapist could suggest some of the best ways for the subjects to discuss their HIV status with friends and families in order to prevent possible social isolation. The central part of the plan, however, is to decrease the stigma across the community.
This can be done by distributing information leaflets that counter widespread negative beliefs about HIV with reputable medical facts. For instance, information on the transmission of HIV would decrease the fear of HIV/AIDS patients and reduce social stigmatization. This would positively impact the subjects self-perception and access to care, as well as enhance their quality of life. Moreover, these interventions would also decrease the community prevalence of HIV, as stigmatization is one of the main factors leading people to hide their status from others, which may result in unintended transmission.
Implementation
The first intervention that was implemented in the aggregate was the referral of subjects to a mental health specialist. The therapist was chosen based on the previous experience of working with HIV-positive patients. The patients were provided with the contact details of the specialist, and informed consent was obtained to share the primary concerns and information with the therapist prior to the appointment. The primary concern indicated was the lack of social support and the subjects refusal to disclose HIV status to friends and family. The participants attended initial appointments separately.
Another intervention that I tried to implement was raising awareness of HIV. Leaflets containing medical information on HIV prevalence and transmission were to be distributed in several local facilities, including medical centers, churches, and community centers. However, most of the facilities refused to distribute the leaflets, which significantly affected the implementation process. The next step of the intervention will include contacting other medical providers in the area for participation in the project and evaluating the effectiveness of the information provided by surveying the target audience.
Evaluation
Overall, the first part of the intervention process was rather productive. During the follow-up meeting with the subjects, most of them agreed that the session with a mental health specialist was useful, as it helped them to understand how to deal with their diagnosis and how to seek the support of friends and family. Social support is a major factor that could assist in reducing impaired social interaction and preventing social isolation in the future. Moreover, social support was proven to lessen the possibility of depression and increase the quality of life of people living with HIV or AIDS (Rao et al., 2012). The issue of stigmatization in the community, on the other hand, remains unaddressed, as the proposed intervention did not yield any results yet.
Conclusion
Overall, the project showed the practical outcomes of AIDS and HIV stigma in the community. Examination of the previous research showed the possible implications of the issue, whereas talking to the patients allowed me to see that the problem of stigmatization is indeed applicable to our community. Further development of the intervention is crucial to achieving the desired outcome, which includes reducing the stigma and promoting social engagement of people diagnosed with HIV or AIDS.
References
Cahill, S., & Valadéz, R. (2013). Growing older with HIV/AIDS: New public health challenges. American Journal of Public Health, 103(3), 7-15.
Dahlui, M., Azahar, N., Bulgiba, A., Zaki, R., Oche, O. M., Adekunjo, F. O., & Chinna, K. (2015). HIV/AIDS Related Stigma and Discrimination against PLWHA in Nigerian Population. PLOS One, 10(12), 1-11.
Herek, G. M., Saha, S., & Burack, J. (2013). Stigma and psychological distress in people with HIV/AIDS. Basic and Applied Social Psychology, 35(1), 41-54.
Katz, I. T., Ryu, A. E., Onuegbu, A. G., Psaros, C., Weiser, S. D., Bangsberg, D. R., & Tsai, A. C. (2013). Impact of HIV-related stigma on treatment adherence: Systematic review and meta-synthesis. Journal of the International AIDS Society, 16(2), 1-25.
Liu, Y., Canada, K., Shi, K., & Corrigan, P. (2012). HIV-related stigma acting as predictors of unemployment of people living with HIV/AIDS. AIDS Care, 24(1), 129-135.
Nyblade, L., Jain, A., Benkirane, M., Li, L., Lohiniva, A. L., McLean, R.,& & Kwena, Z. (2013). A brief, standardized tool for measuring HIV-related stigma among health facility staff: Results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. Journal of the International AIDS Society, 16(2), 70-81.
Rao, D., Chen, W. T., Pearson, C. R., Simoni, J. M., Fredriksen-Goldsen, K., Nelson, K.,& & Zhang, F. (2012). Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing, China. International Journal of STD & AIDS, 23(7), 481-484.
UNAIDS. (2014). Reduction of HIV-related stigma and discrimination. Web.
Varni, S. E., Miller, C. T., McCuin, T., & Solomon, S. (2012). Disengagement and engagement coping with HIV/AIDS stigma and psychological well-being of people with HIV/AIDS. Journal of Social and Clinical Psychology, 31(2), 123-150.
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