SOLUTION
market street mission
The solution I propose involves two parts. One centered at the Market Street Mission to provide more frequent HIV testing for those at the mission and the other at the Family Health Clinic to provide education and prevention seminars to those who come back with positive results.
The Market Street Mission is located at 9 Market Street in Morristown, New Jersey just off the town green. This mission serves as a center for the homeless in Morristown, as, “it serves 250 meals a day to anybody who needs it” and provides, “emergency one night housing for up to forty men” (4A). In addition to this, it provides a 9 month drug rehabilitation center for men (4B). It is strongly affiliated with the church as its core values are: “To respect the dignity of each individual, to be channels of God's reconciliation in this world, to strive for excellence in all that we do, to be good stewards of God's resources, to function in a biblically ethical manner, to conduct ourselves with integrity in each relationship, to seek, above all, Christ's preeminence in all things” (4B). Because of its affiliation with the church and the services it provides for the homeless and recovering drug users, the mission one place where three high risk groups for HIV/AIDS can be found. After speaking with Philip Dosier, a Chaplin at the mission, I found that non-mandatory HIV testing is provided every three months (4A).
As shown above, some of the high risk groups, particularly African Americans and homeless do not believe they are at high risk for HIV/AIDS or are not aware that a treatment even exists. In order to affect more people, it is necessary that testing is provided weekly at the Market Street Mission. For those entering the drug treatment program, the ELISA test with a confirmatory Western Blot should be mandatory. The test attempts to detect HIV antibodies that are present in the body by testing blood or saliva (4E). It 10-14 days to turn out results and costs about $5 a test (4C). The Western Blot is only performed if the ELISA comes back positive and for the test, both false negatives and positives are extremely rare showing that this test is very reliable and accurate (4D). In addition, for those requesting emergency one night housing, the Rapid HIV Test should be compulsory. This test involves the taking of a blood or saliva sample and again tests for the presence of HIV antibodies, costing $15-17 per test (4C, 4E). Results are typically ready within 20-30 minutes and are 99.6% accurate, though results should be confirmed with a second rapid test or an ELISA test (4D, 4E). Rapid HIV Tests should also be available weekly when meals are served. Because the population is only staying one night or just for a meal, it would be difficult to do a follow up ELISA test, as they take a long time.
part of Morristown Memorial Hospital
When positive results are obtained, patients are referred to the Family Health Clinic, a satellite clinic of the Morristown Memorial Hospital, where they can go to receive further medical attention (4A). Recovering drug addicts and homeless populations do not generally have the financial resources available to them to pay for the regimen of medication needed to treat HIV/AIDS. It is unrealistic to expect that funding could be provided to ensure that these people are medicated, so it is important that they learn how to protect others within the community from contracting HIV. I propose that inside this family health clinic, a seminar about condom use tailored to African American populations offered weekly is required of all referred to the center by the Market Street Mission. Because those exiting the drug treatment program are looking to improve their lives and move forward, it will hopefully be easy to convince that group to come to an educational program on HIV/AIDS (4A). For those who receive a positive test result after eating a meal or requesting emergency one night lodging, it will be more difficult, as they may not have the same goals of turning their lives around. However, because the mission is associated with the church, the African American community will most likely respond to this partnership between a health clinic and the church (4G). Because the seminar is not taking place at the church itself and the Chaplin did not shy away from the discussion of HIV/AIDS, I hope that they will be responsive in sending their patients to this seminar.
Studies have shown that African American men and women respond to different educational measures regarding condom use. A study of African American men viewing a videotape about condom use showed positive results (4H). The video depicted black woman who is afflicted with gonorrhea is hospitalized (4H). When she returns, the support of her family gives her the courage to ask her boyfriend to start wearing a condom, which she does very politely and is successful (4H). This video was effective for a number of reasons: “the videotape portrays using condoms as socially acceptable, normative behavior, the focus is on the development of interpersonal communication skills, the protagonist is a woman, it strives to create a sense of identification within viewers, and it attempts to make condoms more sexually appealing” (4H). The results showed that after viewing this tape, the men had a more positive attitude about condom use as well as a greater appreciation for the success of condoms in preventing disease and pregnancy (4H). Men who viewed the tape also had a higher frequency of collecting the free condoms provided as they were leaving the clinic or redeeming the coupons they received by mail for condoms (4H). For my program, I hope to use a similar approach. I intend to show a similar videotape as well as provide condoms for those that leave the session. In addition to this, I would have an African American woman who is afflicted with AIDS and contracted it through heterosexual contact come to speak for the men. In a study concerning the prevention of HIV transmission among African American men, about a half of the men said they practiced safe sex because they knew someone who died of AIDS or was severely affected by it (4I). Combined with this is the finding in the previous study that seeing the effects of condom use (or lack thereof) on women were one reason why the videotape was successful (4H). Meals will also be provided as another incentive to ensure that patients attend. In addition, so the people do not have to get to the clinic on their own, I would provide a van to pick the patients up at the Market Street Mission at a given time.
For women, I would take a different approach. The SISTA (Sisters Informing Sisters about Topics on AIDS) has proven effective for educational intervention African American women (4J). Involving the training of two people to conduct the seminar, this program gets at the core issues by tackling the problems that African American can sometimes have when negotiating condom use and discussing what it means to be an African American woman (4J). The main goals of the program are: “conduct small-group sessions…addressing challenges and joys of being an African American woman, utilize skilled facilitators, utilize cultural and gender appropriate materials to acknowledge pride and enhance self worth in being an African American woman, train women in sexual assertion skills, teach women proper condom use, discuss cultural and gender triggers that make it challenging for women to negotiate safer sex, and emphasize the importance of partner involvement in safe sex” (4J). When this program was implemented on the West Coast for 18-29 year old African American women, it was successful in ensuring that women were consistent in their condom use (4J). Designed to foster a sense of community and shared struggles, two women who pass a four day long training lead the intervention program (4J). I hope to implement this type of a program in the Family Health Clinic, as it seems to be effective in addressing the issues at the core of the AIDS epidemic in African American women. Similar to the program with men, I hope to provide transportation to the patients attending the session as well as meals as extra incentive. Free condoms will also be distributed.