Purpose

The purpose of this assignment is to

· Provide learners with the opportunity to integrate knowledge and skills learned throughout this course

· Directly apply principles and knowledge learned in the course to problem solving of population health problems in marginalized women.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

1. Integrate current evidence based clinical practice guidelines in the care of childbearing and childrearing families.

2. Appropriately apply anticipatory guidance and health promotion in the care of childbearing and childrearing families.

3. Assess growth and developmental milestones in the care of childbearing and childrearing families.

4. Construct an evidence based reproductive health management plan.

5. Identify and address healthcare needs of marginalized childbearing and childrearing families

Requirements

This paper should clearly and comprehensively identify the disease or population health problem chosen. The problem must be an issue in your geographic area and a concern for the population you will serve upon graduation with your degree. The paper should be organized into the following sections:

1. Introduction with a clear presentation of the marginalized group as well as significance and a scholarly overview of the paper.

2. Background of the marginalized group/problem including description, current incidence and/or prevalence statistics current state, local, and national statistics pertaining to the problem.

3. Discuss the economic aspects of the marginalized group

4. Discuss social justice and its relationship to health disparities and health care of marginalized group.

5. Discuss ethical issues on marginalized group

6. Provide a brief plan of how you will address this marginalized group in your practice once you are finished with school. Provide three actions you will take along with how you will measure outcomes of your actions.

7. Conclude in a clear manner with a brief overview of key points of the entire problem

Preparing the Paper

Choose one topic from the following list:

· Female Veterans

· Incarcerated Women

· Lesbians

· Transgender Women

· Women with HIV

· Women Sex Workers

· Women with Mental Illness

· Women Immigrants

· Women with Past Sexual Assault

Paper Length: 5-6 pages, excluding title/cover and reference pages

APA format 6th edition

Once you have submitted your second submission to the grade book dropbox, it will be considered final and subject for grading.

Criteria Ratings Pts
This criterion is linked to a Learning OutcomeIdentification of the chosen marginalized group
20.0 pts

Exceptional- Comprehensively identifies the chosen marginalized group.

18.0 pts

Exceeds- Adequately identifies chosen marginalized group.

16.0 pts

Meets- Identification of chosen marginalized group is limited.

8.0 pts

Needs Improvement- Identification of chosen marginalized group is unclear.

0.0 pts

Developing- Identification of chosen marginalized group is missing or not discussed.

20.0 pts
This criterion is linked to a Learning OutcomeBackground and significance of the marginalized group (includes incidence and prevalence statistics)
20.0 pts

Exceptional- Comprehensive review of background and significance of chosen marginalized group. Current evidence supports background.

18.0 pts

Exceeds- An adequate review of background but limited review of incidence or prevalence. Current evidence supports background and significance.

16.0 pts

Meets- Limited review of Background AND limited review of incidence/prevalence. OR Lack current evidence to support.

8.0 pts

Needs Improvement- Background, incidence and prevalence is unclear. missing one or more key point (background, prevelance or incidence). AND Lack of evidence to support.

0.0 pts

Developing-Background and significance of the marginalized group is not discussed.

20.0 pts
This criterion is linked to a Learning OutcomeSocio-Economic issues of the problem
20.0 pts

Exceptional- Clearly presents and fully explains the socio economic issues of marginalized group with current supporting evidence.

18.0 pts

Exceeds-Adequate review of socio-economic issues of marginalized group with current supporting evidence.

16.0 pts

Meets- Limited review of the socio-economic issues of marginalized group OR Lack of current supporting evidence.

8.0 pts

Needs Improvement- Minimal or unclear review socio-economic issues of marginalized group AND lack of current supporting evidence.

0.0 pts

Developing-Socio-Economic issue(s) not reviewed.

20.0 pts
This criterion is linked to a Learning OutcomeSocial justice and its relationship to health disparities and health care of chosen marginalized group
20.0 pts

Exceptional- Comprehensive review social injustice is discussed along with its relationship to health disparitities and health care. Supported by current scholarly evidence.

18.0 pts

Exceeds- Adequate review of social injustice with some discussio of its relationship to health disparities and health care but lacks one major point or is not succinct. supported by current scholarly evidence.

16.0 pts

Meets- Limited review of social injustice. Limitied discussion of relationship to health disparitities and health care. Main points lack detailed development. Supported by current scholarly evidence

8.0 pts

Needs Improvement- Minimal review of social injustice. Minimal discussion of relationship to health disparitities and health care. OR Information presented is NOT Supported by current scholarly evidence.

0.0 pts

Developing- No discussion of social injustice and relationship to health disparitities and health care.

20.0 pts
This criterion is linked to a Learning OutcomeEthical issues of the chosen marginalized group
25.0 pts

Exceptional- Comprehensive review of ethical issues current supporting evidence.

22.0 pts

Exceeds- Adequate review of ethical issues. Main points lack detailed development. Current supporting evidence.

21.0 pts

Meets- Limited review of ethical issues. list ethical issues or arrange them randomly rather than using any logical structure. OR Lack of cuurent supporting evidence.

10.0 pts

Needs Improvement- Minimal or unclear review of ethical issues AND lack of current supporting evidence.

0.0 pts

Developing- Ethical issues are not discussed.

25.0 pts
This criterion is linked to a Learning OutcomePlan of action (includes at least three evidenced based actions, supported by literature, that the student will take in their own practice and how outcomes will be measured)
30.0 pts

Exceptional- A comprehensive plan of action specific to the chosen marginalized group; three evidence-based actions to address the impact AND outcomes of the marginalized group. Supported by current scholarly evidence.

26.0 pts

Exceeds- An adequate, but not fully comprehensive, plan of action specific to the chosen marginalized group; OR Two evidence- based actions fully discussed to address the impact AND outcomes of the marginalized group. Supported by current scholarly evidence.

24.0 pts

Meets- A limited plan of action specific to the chosen marginalized group; Two evidence-based actions discussed to address the impact. Outcomes not discussed. Limited or little current evidence used for support.

12.0 pts

Needs Improvement- Plan is unclear OR One evidence- based actions discussed to address the impact. Outcomes not discussed AND Lack of current supporting evidence.

0.0 pts

Developing- Plan of action not provided.

30.0 pts
This criterion is linked to a Learning OutcomeConclusion
10.0 pts

Exceptional- The conclusion thoroughly, clearly, succinctly, and logically presents major points of the paper with clear direction for action.

9.0 pts

Exceeds- The conclusion adequately and logically presents major points of the paper with clear direction for action, but lacks one major point or is not succinct.

8.0 pts

Meets- The conclusion is a limited review of key points of the paper, is not succinct, or lacks one or more major points of the paper or clear direction for action.

4.0 pts

Needs Improvement- Conclusion is unclear or significantly limited in overview of the paper.

0.0 pts

Developing- Conclusion not provided.

10.0 pts
This criterion is linked to a Learning OutcomeGrammar, Spelling, APA
5.0 pts

Exceptional- APA format, grammar, spelling, and/or punctuation are accurate, or with zero errors.

4.0 pts

Exceeds- One to three errors in APA format, grammar, spelling, and syntax noted.

3.0 pts

Meets- Four to six errors in APA format, grammar, spelling, and syntax noted.

2.0 pts

Needs Improvement- Seven to nine errors in APA format, grammar, spelling, and syntax noted.

0.0 pts

Developing- Post contains ten or more errors in APA format, grammar, spelling, and punctuation OR repeatedly makes the same errors throughout the paper.

5.0 pts
Total Points: 150.0

1

Running head: WOMEN WITH HIV

2

Running head: WOMEN WITH HIV

Women with HIV

NR602

February 2019

Women with HIV

Human Immunodeficiency Virus (HIV) is an infection that affects all populations, irrespective of gender, ethnicity, race and social status. The virus was first discovered in the year 1981 and since then, many trials and researches have been conducted to find its cure. It has been noted that HIV has disproportionately affected women as well as adolescent girls. This is attributed the unequal social, cultural, and economic status of the female gender in society. In the United States, for every four people infected with HIV, one is a woman. All women regardless of age, ethnicity, and race can get infected with HIV; however, some women have a higher risk compared to others (Karbinski, Rosenberg, & Paz-Bailey, 2015). This paper identifies women infected with HIV as one of the marginalized groups in the society. It gives an overview and extensively describes the available demographic and epidemiologic data (incidence and prevalence), the economic aspects, social justice, and how it relates to the healthcare and health disparities of the group, associated ethical issues, and a realistic plan on how to address the marginalized group.

Background

The prevalence of HIV has been recorded as the highest specifically among the groups or members of the society who are most marginalized. It is evident that HIV disproportionately affects the individuals who have the least access or those that lack healthcare services and those who face the most discrimination (Paudel & Baral, 2015). The marginalized groups that have higher risk of acquiring HIV infection include, users of injection as well as the non-injection drugs, the mentally ill, sexual minorities, prisoners, racial minorities, illegal immigrants, refugees, the poor, commercial sex workers, homeless, and also those who lack insurance (Bertrand, Chan, Howe, Comella, Marak, & Bandy, 2016). The women who live with HIV have also suffered significant discrimination and vulnerabilities, hence form part of the marginalized groups.

Women have a higher risk of being infected with HIV because of various reasons. Some include intimate partner violence, unsafe traditional practices, and inequitable laws that reinforce or otherwise propagate unequal power dynamics between the males and females in the society. Women are more prone to the risk of rape and molestation, causing more vulnerability to being infected. Young women are the most disadvantaged. It is true that gender inequality mainly contributes to the high numbers of women with HIV and more so entrenches gender inequality (Paudel & Baral, 2015).

In 2017, there was approximately 36.9 million people worldwide living with HIV. More than 1.1 million people in the U.S. are living with HIV and 1 out of 7 people are unaware of having the disease, (HIV.gov, 2017). According to AIDSVu (2019), in 2015 there are approximately 106,585 people living with HIV in Florida, with 28.4% being female. In 2016, there were 4,940 new diagnoses of HIV. There are approximately 19,465 people living with HIV in Fort Lauderdale, Florida, with 26.4% being female. There were 762 new diagnoses in 2016, with 22.5% being female (AIDSVu, 2019).

Economic Aspects

Both at the local and international level, HIV plays a huge role in economic inequity for it affects the marginalized groups at a rate that is disproportionately high. Research shows that an individual’s socioeconomic status determines the likelihood of getting infected. It is also a key determiner of a person’s quality of life once they are diagnosed with HIV. For some women living with HIV, their situation has had a negative impact on their progress and development economically in various ways, such as consequences of stigma and discrimination, getting ill for long durations, access to health services, and the disease getting more severe. Increased levels of stigma are associated with decreased social support, being viewed negatively and weak, and decreased physical and mental outcomes. Many women also lose their jobs leading to a decrease in income and degrade of dignity (Kontomanolis, Michalopoulos, Gkasdaris, & Fasoulakis, 2017).

Social Justice

Marginalization of women with HIV has led to them being isolated and consequently losing their power within society as a result of discrimination. Women have an increased likelihood of being marginalized, unlike men due to their gender. The HIV risk or status can also make a woman get marginalized and she may experience more intense stigma if she belongs to a group in relation to her sexual orientation or race. To prevent stigma and discrimination of women with HIV, women need to be protected and receive equal treatment in society.

People with HIV are less likely to have access to healthcare and are less likely to have health insurance. Such marginalization’s discussed above, can make current HIV prevention messages and tools inaccessible to many. There is a need for HIV prevention tools that will enable protection. A pre-exposure prophylaxis (PrEP) is an effective HIV prevention program. It involves the use of HIV treatment medications to protect uninfected individuals from the infection and has been shown to prevent the infection by up to 92% (Philpott, 2013). The issue is that the prevalence of HIV is high for all racial and ethnic minorities, non-minorities, including men and women. There are two aspects of social justice; population-level health improvement and fair treatment of the disadvantaged need to be considered when developing publicly funded PrEP program. The goal is to address the needs of the disadvantages and vulnerabilities of the community in order to provide better health (Philpott, 2013).

Ethical Issues

There are various ethical issues that need to be considered in regards to HIV. Treatment of women with HIV has raised various ethical issues, calling for the need to have a concrete understanding about ethical decision making to aid in ensuring that arising problems are dealt with in a manner that is morally appropriate.

The ethical issues mainly involve “the standard of care, informed consent across cultures, privacy and confidentiality, stigma and discrimination, protection of vulnerable groups, community consultation, ethical review mechanisms, international collaboration, epidemiological studies, clinical trials, and sociobehavioural studies” (Hlongwa, 2016). Confidentiality is important and because of the sensitivity of information related to HIV, the laws of the U.S. offer additional protection to medical records that are HIV-related (Hlongwa, 2016). In the U.S., patients with HIV can apply for Medicaid. However, there is a stigma associated with Medicaid, being undereducated and poor. Patients with HIV deserve to be treated with the same respect and receive judgment-free healthcare.

Action Plan

To achieve successful prevention of HIV, there is a need to challenge discrimination and negative attitudes faced by individuals who are HIV-infected, affected, or are at risk of acquiring the infection. As a provider, there are actions that can be taken to make a difference in the community. It would be crucial to create an environment that empowers women and makes women feel comfortable and safe to talk about the associated risk of acquiring HIV. Women should have access to testing services, care, and be able to disclose the HIV status without fear of being judged or discriminated as a way of combating the spread of HIV. It calls for joined efforts to challenging the stigma women face as well as their sexual behaviour to aid making the feel nurtured, accepted and respected. The following are actions plans that providers can take to address this marginalized group.

1. Conducting risk screening for HIV can be used to identify patients who should receive more in depth risk assessment and HIV risk reduction counseling, interventions, or referral for other services. Screening should be made a routine part of all patients healthcare, probing for behaviors associated with transmission of HIV and other STDs, eliciting patient reports of symptoms, and laboratory testing. A measurable outcome would be to decrease the incidence of HIV within the community (CDC 2017).

2. As provider, increasing access to care and improving health outcomes for people living with HIV should be implemented in practice. Providers should develop a trusting relationship with their patients in order for patients to open up and speak freely about their needs. Providers should develop a rapport with all patients and understand that the diagnosis of HIV is a sensitive topic and should be approached honesty and respect. Care and support is important in order to facilitate immediate access to treatment when a person is diagnosed with HIV, to support adherence to treatment in order to attain viral suppression, for the sake of their own health and to prevent infecting other people with HIV, to enhance the prevention and management of HIV related infections, and to enhance coping with the challenges of living with HIV (UNAIDS.org). A measureable outcome would be to heighten women’s mentality on the subject and decrease negative judgment and stigma.

3. Another plan is to reduce HIV related health disparities. Regardless of insurance, patients should be provided equal nonjudgmental care. There are resources that patients can seek in order to receive the care they need. Providers should become familiar with community services related to care and treatment in order to provide to their patients. The Affordable Care Act provides better access to health coverage and more health insurance options, including coverage for people with pre-existing conditions, broader Medicaid eligibility, more affordable coverage, lower prescription drug costs (HIV.gov). An outcome would be to provide care to more patients who have limited access to health care and limited insurance coverage.

Conclusion

Women who are HIV-infected still face heightened levels of discrimination and isolation in society and this further contributes to the deterioration of their health among other associated problems. This paper identified women infected with HIV as one of the marginalized groups in the society. This paper discussed an overview of the marginalized group, demographic and epidemiologic data (incidence and prevalence), and economic aspects, social justice relates to the healthcare and health disparities of the group, ethical issues, and a realistic plan on how to address the marginalized group. There is a need to prevent stigma and ensure healthcare services are affordable and accessible to all with ease in order to help combat the spread of HIV infection and improve the health and wellness outcomes of this marginalized group.

Reference

AIDSVu. (2019). Local Data: Florida. Retrieved from https://aidsvu.org/state/florida/

Bertrand, T., Chan. P. A., Howe, K., Comella, J., Marak, T., & Bandy, U. (2016). Health equity, social justice, and HIV in Rhode Island: A contemporary challenge. Rhode Island Medical Journal (2013), vol. 99, 11 21-24. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5522175

Centers for Disease Control and Prevention [CDC]. (2017). HIV testing. Retrieved from https://www.cdc.gov/hiv/guidelines/testing.html

German, D., Linton, S., Cassidy-Stewart, H., & Flynn, C. (2014). Using Baltimore HIV behavioral surveillance data for local HIV prevention planning. AIDS And Behavior, 18 Suppl 3, 359-369. https://doi.org.chamberlainuniversity.idm.oclc.org/10.1007/s10461- 013-0513-1

HIV.gov. (2019). The affordable care act and HIV/AIDS. Retrieved from https://www.hiv.gov/federal-response/polcies-issues/the-affordable-care-act-and-hiv-aids

HIV.gov (2017). U.S. statistics. Retrieved from https://www.hiv.gov/hiv- basics/overview/data- and-trends/statistics

Hlongwa, P. (2016). Current ethical issues in HIV/AIDS research and HIV/AIDS care. Oral Diseases. Retrieved from https://onelinelibrary.wiley.com/doi/epdf/10.1111/odi.12391

Karbinski, Rosenberg, & Paz-Bailey. (2015). Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med, 175 (4), 588- 596.

Kontomanolis, E., N., Michalopoulos, S., Gkasdaris, G., & Fasoulakis, Z. (2017). The social stigma of HIV-AIDS: Society’s role. HIV AIDS (Auckland, N. Z.), 9, 111- 118. doi:10.2147/hiv.s129992

Paudel, V., & Baral, K. (2015). Women living with HIV/AIDS (wlha), battling stigma, discrimination and denial and the role of support groups as a coping strategy: A review of literature. Reproductive Health, 12(53). Retrieved from https://www.ncbi.nlm.gov/pmc/articles/PMC4467680/

Philphott, S. (2013). Social justice, public health ethics, and the use of HIV pre-expose prophylaxis. American Journal of Preventative Medicine, 44(12), 137-140. Retrieved from https://www.ajpmonline.org/article/S0749-3797(12)00683-6/pdf

UNAIDS.org. (2019). The importance of HIV care and support services. Retrieved from www.unaids.org/een/resources/presscentre/featurestories/2016/december/20161202_HIV -care

 
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