HIV Prevention in African American Women

Introduction

From its origin, HIV/AIDS has been defined as a sexually transmitted disease associated primarily with white homosexual men. In fact, African Americans are the racial/ethnic groups that are mostly influenced by HIV/AIDs. According to the Center of Disease Control and Prevention, by the end of 2008, an estimated 240,627 blacks with and AIDs diagnosis has died in the United States (CDC, 2012). Contrary to the evident statistics affecting the African American population as a whole, there remains a small amount of research studies, dedicated towards HIV/AIDs healthcare promotion and prevention strategies specifically designed for the African American women. However, there are a large proportion of African American women affected by HIV/AIDs. In 2009, black women accounts for 30% of the new estimations of HIV infections among blacks. The rate for HIV infections as compared to other populations is 15 times more than white women, and three times as high for Latina women (CDC, 2012). This is confirmed by social media, primarily directed at African American males. In regards to the African American women, personal beliefs, cultural practices, and social norms act as a backdrop in determining the risk behavior of acquiring HIV/AIDs. This study serves to address the need for prevention strategies among single African American women of 18-22 years of age in college from the middle socioeconomic class. The subjects for the study are voluntary and motivated to learn with no developmental barriers noted. In particular, the study will investigate the use of sexual barriers among the college women as a preventive measure against HIV/AIDs and their overall knowledge of protective barriers and risk behaviors.
Model
The Health Belief Model is centered upon a client’s belief in his or her own personal susceptibility and severity of a health condition as significant denominators that influence the motivation of health-conscious behaviors (Rankin, Stallings, 1996). Exploring the definition of individual healthcare beliefs is important to acknowledge in order encouraging effective healthcare behaviors in the prevention of HIV/AIDs. The Health Belief Model assists in the understanding of patient motivation in the adaptation of behaviors that do not place the clients at risk. Although there are various variables to address, the emotional, cultural and social meanings attached to sexual behavior are one of the firsthand factors in the higher prevalence and increasing incidence rates of HIV, AIDs, and other STDs among African American women (Foreman, 2003). The patient education process is propagated through firsthand understanding of the reasoning and thought processes concerned with the risk behavior. This way, the clients will be able to understand how personal preferences can directly lead to increased risks of acquiring HIV/AIDs. Utilizing the Health Belief Model, the main focus is to target African American females sexually active to investigate their healthcare beliefs and actions concerning the usage of protective sexual barriers.

Objectives
* After reading an informational pamphlet on HIV/AIDs, the students will list effective sexual contraceptive barriers
* After watching a video on the risk behaviors specific to African American women, the students will identify risk behaviors pertinent to culture and ethnicity.
* After watching a video pertaining to African American women as a risk population for HIV/AIDs, the students will express their opinion on African American women as an at-risk group in relation to HIV/AIDs.
* After reading a profile of an African American female who had a new case of HIV/AIDs, the women will state how their own attitudes can lead to risk behaviors associated with HIV/AIDs.
Risk Behaviors
Firstly, it is most important to evaluate the factors involved in the acquisition of HIV/AIDs. Among the common social variables, such as deficient knowledge, barriers in the access of information, there is one main criteria, which has a direct link with the HIV/AIDs risk behaviors. Low rates of condom use indicate that heterosexual African American women may not perceive themselves as at risk for acquiring HIV/AIDs (McNair, Prather, 2004). Various variables attribute to inadequate condom use in sexual practices concerning African women. This may include inconvenience, fear of reprisal, a negative perception of condom usage, and the generated belief that it does not constitute as a risk behavior. Moreover, the real concern is not deficient knowledge in relation to sexual contraceptives. It pertains to a refusal to acknowledge the risks of not using an effective contraceptive barrier. Furthermore, the sex-ratio imbalance in the African American community heightens the difficulty in negotiating condom usage with male sexual partners (McNair, Prather, 2004). According to Cornelius, Okundaye, and Manning (2000), only one third of African American women aged 14-44 years reported that their partners always used condoms (McNair, Prather, 2004). Not enough healthcare resources are available to the African American women. Condom samples are primarily provided to men as a preventive measure to protect their partner and themselves. Therefore, the decision lies in the hands of the dominant male. The imbalance of males and females results in lower levels of interpersonal power, consequently due to more options available to men. Unfortunately, the female to male relationship plays a role in dictating sexual behavioral patterns. Therefore, the reasoning as well as the decision to use or not to use sexual contraceptives should be assessed.
Instruction Strategies
Existing HIV/AIDS prevention programs are not designed for African American women. Most HIV/AIDS prevention programs target teenagers, uneducated black women in poverty with high unemployment, or youth living in low-income neighborhoods (Alleyne, Wodarski, 2009). Today young people no matter what nationality are media savage and we as educators have to address them as such. With all types of media, it is necessary to include discussion as a means to connect all the information together and to reinforce key points. Media that will be included consist of an educational video, informational pamphlet, campus-acquired brochure, and a case study on HIV/AIDs. Educational videos promote learning when carefully selected, introduced, and integrated into patient teaching. The informational pamphlet or brochure is regarded as the most popular teaching tool, as it offers an individualized teaching plan as relevant to the individual. All materials with exception of the campus-acquired brochure will be specific to the group of African American female college students to further learning based upon cultural and social needs.

Evaluation Strategies
Evaluation strategies are used to check the effectiveness of a teaching program. Measured learning outcomes are emphasized by the Joint Commission on the Accreditation of Healthcare Organizations as a necessary step in measuring learned behaviors (CDC, 2012). Measuring learning outcomes can be regularly accomplished in any setting. Common evaluation methods used are questionnaires, interviews, and feedback. All methods assess expectations, opinions, and the degree of confidence in new knowledge and self-efficacy (Rankin, Stalling, 1996). After the teaching, the learners should be assessed if they have acquired the skills, knowledge, and attitudes as defined in the objectives. Questionnaires are regularly conducted to assess the fulfillment of the program objectives. Questionnaires will be based upon the Likert scale, which asks participants to rate questions based upon the extent that they agree or disagree with the question (Edmondson, 2005). Based upon a numerical scale, attitudes will correspond with the following: 1=strongly disagree, 2=disagree, 3=not sure, 4=agree, and 5=strongly agree. This format enables certain social responses to be grouped comparatively. Feedback is also a communicative mechanism, which may not be specifically measured. Instead, it opens a perspective on the personal opinion and involves the sharing of perceptions. Feedback is constructive in nature, and enables the teaching program to improve on certain points in the future. Feedback may either be verbal or written as part of the questionnaire. Through the following strategies described, the objectives of the program will be measured for its effectiveness.

Evaluation Form
* Do you currently believe that your ethnic population is an at-risk population for the development of HIV/AIDs?
* Has this program educated you in regards to sexual contraceptives and their usage?
* Are the utilized media effective for the teaching objectives?
* Has this program convinced you to use sexual contraceptives more readily, if not already adopted?
* Do you currently always use sexual contraceptive barriers with your partner?

* Are you in an exclusive relationship?
* Do you believe that the information supplied was relevant to your ethnic population?

Aspects to Evaluate
The aspects to evaluate serve as an integral part of the educational program. A strong evaluation approach ensures that the aspects covered are relevant to the evidence presented in the educational study (CDC, 2011). Aspects are the individual criteria, which dictate the success of an educational approach. Aspects to evaluate can be grouped into the following categories: planning and preparation, the educational environment, instruction, educational material, and professional responsibilities (Santiago, Benavides, 2009). Planning and preparation constitutes the knowledge of content and the effectiveness of the presentations, clarity of instructional goals, easily comprehensible instruction, and purposeful activities. The educational environment is evaluated based upon the maintenance of respect and rapport, upholding classroom regulations and procedures, organization of physical space, and the management of student behavior. Instruction is assessed by the following qualities: clear and accurate communication, the utilization of questioning and discussion techniques, engagement of the students in learning activities, and easy responsiveness/feedback to students. The educational media used will be evaluated for their straightforward message, easy accessibility, and ability to engage the audience. Furthermore, evaluation methods will be assessed for the ability to capture accurate and relevant information needed to evaluate the program’s effectiveness. In conclusion, the aspects for evaluation describe the steps to examining the program’s efficacy for future studies.

Conclusion
The purpose of this health promotion is to educate and teach live saving techniques to African American women of child bearing age. Healthcare attitudes and the will to change current sexual practices will be reviewed through questionnaires and feedback. The program evaluation will review the effectiveness of the teaching method and media involved. The subjects involved are only a partition of a large ethnic group but with proper education the spread of knowledge will be effective within the community.
References

Alleyne, B. & Wodarski, J. (2009). Psychosocial factors that contribute to HIV/AIDS risk behavior among young black college women. Journal of Human Behavior in the Social Environment. 19, 142-158.

Center of Disease Control and Prevention. (2011). A framework for program evaluation. Retrieved from http://www.cdc.gov/eval/framework/index.htm

Center of Disease Control and Prevention. (2012). HIV in African Americans. Retrieved from http://www.cdc.gov/hiv/topics/aa/index.htm

Edmondson, D.R. (2005). Likert scales: a history. Conference on Historical Analysis and Research in Marketing. Retrieved from http://faculty.quinnipiac.edu/charm/CHARM%20proceedings/CHARM%20article%20archive%20pdf%20format/Volume%2012%202005/127%20edmondson.pdf

Foreman, F.E. (2003). Intimate risk: sexual risk behavior among African American college women. Journal of Black Studies. 33(5), 637-653. Retrieved from http://www.jstor.org/stable/3180980

McNair, L.D. & Prather, C.M. (2004). African American women and AIDS: factors influencing risk. Journal of Black Psychology. 30, 106-118.

Rankin, S.H., Stallings, K.D., & London, F. (1996). Patient Education in Health and Illness. Lippincott Philadelphia, PA: Williams and Wilkins.

Santiago, P. & Benavides, F. (2009). Teacher evaluation: a conceptual framework and examples of country practices. Organization for Economic Co-operation and Development.