So what is the best way to approach the HIV/AIDS problem in Montgomery County? Because Maryland does not provide any information regarding the number of new HIV infections, it is difficult to know whether the rate of infection is increasing or decreasing. Yet, currently Maryland’s AIDS Administration has recognized the presence of an HIV/AIDS problem within the state and has already devised several prevention programs for particular “priority populations.” These such approaches include a needle-exchange program (in Baltimore), “Extra Steps,” an in-treatment program of group sessions teaching injection-drug users risks and safe practices, “Healthy Relationships,” a community-based organization teaching HIV prevention to men who have sex with men, and “Project Smart,” a 5-8 week program teaching incarcerated HIV positive and high-risk behavior men and women methods to protect themselves (http://www.dhmh.state.md.us/AIDS/Prevention/PrevPrograms/prevProgPriorityPop.htm). As this organization is based in Baltimore, these efforts are not tailored to the individual needs of each county, but do provide important and valuable interventions for the at-risk population of Maryland. After studying who and where these individuals are infected, as well as identifying correlations between various demographic characteristics and AIDS rates throughout the county, I propose a solution of several combined means of both treatment and prevention. The most effective method to combat AIDS in Montgomery County would be a multifaceted approach in which contraceptives and clean needles are made available, proper education and treatment is reinforced in schools and high risk communities, and men on the “down low” are identified and provided with information to lead healthier lifestyles.

     The primary preventative measure that should be implemented throughout the county is asserting the necessity of condoms and the support of a needle exchange program. One of the most common ways to promote safe sex practices is to ensure contraceptives are readily available and highly recommended. Condoms can prevent the transmission of HIV and AIDS for both heterosexual intercourse as well as male-to-male sexual contact, although the CDC insists abstinence is the best method to prevent HIV/AIDS (CDC. Fact Sheet for Public Heath Personnel). The increased availability of condoms alone could lead to a higher consistency of usage (Blake; 2003). Therefore by placing kits including contraceptives and information regarding healthy sexual practices in high-risk areas around the county, particularly in various locations around Gaithersburg and Silver Spring, may be an initial step in decreasing the transmission of AIDS. Additionally, government support for a needle exchange program in Montgomery County would decrease risks for the disease.

    Baltimore, Maryland played a forefront role in introducing the needle exchange program where injection drug users could trade in their soiled needles for clean ones. The opposition consider this approach to be endorsing and even encouraging the use of illicit drugs, when in fact such a program promotes a safer environment for those participators. As injection drug use accounts for 11.60% of the mode of transmission for HIV/AIDS in Montgomery County, the most appropriate method to combat this problem would be to introduce a van containing the necessary materials, which would travel to various high-risk locations around the county. Similar to the distribution of contraceptives, it is possible that the availability of clean needles would diminish the likelihood of using needles repeatedly (Ramaswamy; 2006). Any other means of prevention through needle exchange would actually be detrimental, as law enforcement agents may be attracted to similar areas and prosecute users, thus establishing distrust with the prevention program. Moreover, funding would be better appropriated supporting other anti-AIDS methods, such as implementing community-based organizations for at-risk locations around the county.

    The availability of contraceptives and clean needles is just one step in the anti-AIDS prevention effort for Montgomery County - education in the school systems must also be implemented. When comparing the relationship between various demographics and the AIDS Rate, it was discovered that the correlation between the AIDS Rate vs each the White and Hispanic populations enrolled in Kindergarten through 12th grade was significant and negative, indicating that those enrolled in school are less likely to have AIDS. (While the same correlation for the Black population was slightly positive, it was insignificant.) This reinforces the concept that education about HIV/AIDS must be made readily available, particularly in schools, to promote safer sex practices. More specifically, a skills-based information session would be most effective method to reduce risky behavior, and should also be implemented in the school system (Jemmott; 2005). This education plan should be required in all schools, while additional prevention techniques should be tailored to specific at-risk populations around the county.

    It was previously determined that both the Black and Hispanic populations suffered from an AIDS problem in Montgomery County. (AIDS Rates by Race) Earlier research revealed that Blacks had and AIDS rate of 999 cases per 100,000 people, almost 3 times the national AIDS rate of 339. This information indicates that a problem exists in Montgomery County’s Black community. The correlation between the Black population and the AIDS rate was both positive and significant, and when mapped, the high risk zip codes are located adjacent to the district line, specifically being 20910, 20912, 20903, 20904, 20905 and 20866. One way to respond to the AIDS crisis within the Black population in Montgomery County is to turn to the religious community. As the pastor is revered as a spiritual leader and often plays a principle role in the lives of many Black individuals, the pastors’ support for a prevention program is crucial to the fight against AIDS (Hicks; 2005). While the church, itself, may not be able to provide more than messages of prevention, the advocacy of abstinence or contraception could reinforce safer sex methods. Additionally, the religious community could be offered as another source for individuals interested in gaining more information about the anti-AIDS effort that may not have to be limited to the Black population.

    The correlation between the Hispanic population and the AIDS rate was, similarly, also positive and significant, mapping parallel zip codes as well as 20877 and 20880. An ideal prevention approach for reinforcing a healthy lifestyle in these high-risk areas regardless of race is to create a community-based program. Community organizations provide a certain support network that can promote a positive self-image and encourage safe sex as a common practice (Ramirez-Valles; 2003). This type of program not only instills a sense of personal acceptance, but also, and what is more important, a modification in the behavior for the entirety of the community (Ramirez-Valles; 2002). The network established through such organizations reduces the individuality of having to suffer or, in contrast, promote AIDS prevention alone. However,  these volunteer efforts sometimes have limited participation. The lack of any combination of education, class and money can prevent volunteerism which may force a number of individuals from a certain population to avoid these community-based organizations (Wilson & Musick; 1997). Due to the lack of education, especially regarding HIV/AIDS prevention, and medical facilities, risky behaviors may be the only option for those living under the poverty line (Fenton; 2004). This reinforces the importance of the availability of contraceptives and clean needles in all communities, particularly for Blacks and Hispanics living under the poverty line, as the percentages of these populations produced a positive, significant correlation when compared with Montgomery County’s AIDS rate. Although insufficient education and a lower class are not the only deterrents from a community-based prevention program. The association with homosexuality, in fact, forces some to remain absent from such organizations. Some fear the stigma of being a gay person with AIDS and the associated prejudice and discrimination (Herek; 1999). By enrolling in one of these community-based prevention programs, one announces his illness to the public and sometimes the Latino or Black populations deem this and the assumed homosexual behavior unacceptable. Therefore these men, in particular, remain on the “down-low.”

    Men on the “down-low” identify as heterosexuals but also have sex with other men (MSM). It is likely there is a “down-low” problem in Montgomery County due to the fact that the primary means of transmission of HIV/AIDS is MSM (41.70%) followed by heterosexual contact (24.60%) yet, the correlation between the percent of male householders with male partners is insignificant, revealing the resident gay population within the county is not directly associated with the AIDS rate. Moreover, while gay/lesbian publications such as the Metro Weekly and the Washington Blade are distributed sparsely in certain zip codes (such as 20814, 20815, 20850 and 20852), homosexual nightclubs and bars are located in surrounding areas in Washington D.C. and Baltimore ( http://www.metroweekly.com/about_us/where.php). In order to solve the HIV/AIDS crisis in Montgomery County, it is critical to identify these “down-low” men so that they practice safe sexual behaviors with both their male and female partners. One of the primary reasons these men are hard to identify is their wanting to preserve their anonymity. Black men in particular “face double-isms: racism and sexism, including homophobia” (Richard; 2001). Similar to the association with a community-based prevention program, these men do not want to be recognized as having sex with other men. In conjunction with previously-suggested HIV/AIDS prevention strategies, determining the prevalence of STI’s among Black or Hispanic populations could indicate these “down-low” men, as such infections allow for easier transmission of HIV, and the infections could have developed prior to a current heterosexual relationship (Bleich). Another technique in attempting to promote safer sex practices among men on the “down-low” is to encourage peer education. In the high-risk areas previously identified for Blacks and even Hispanics throughout the county, a prevention program mimicking Washington D.C.’s “Us Helping Us” campaign which distributes Down Low Condom kits in nightclubs and barbershops could help encourage safe sex practices. Additionally, barbershop staff members are trained down-low peer educators (Richard; 2001). These educators are those who the at-risk population will connect and identify with, and by including members of the general population in this training, victims of HIV/AIDS may be more inclined to take protective measures when advised by their own peers.

    One of the most effective preventative organizations in the media is the truth Campaign advocating the cessation and rejection of smoking tobacco (85% of 12-17 year-olds found advertisements effective) (http://www.protectthetruth.org/truthcampaign.htm). A similar large-scale campaign implementing anti-AIDS measures targeted at the right communities would allow for a greater awareness and understanding of  HIV/AIDS risk factors. Several HIV/AIDS prevention campaigns have already been launched including “KNOW HIV/AIDS,” which issues television, radio, online and print media public service messages, MTV’s “Fight For Your Rights: Protect Yourself” encouraging HIV testing and prevention in adolescents, and BET’s “Rap It Up” which “seeks to help African American youth and families protect against HIV/AIDS related illnesses and diminish the occurrence of HIV/AIDS” (http://www.bet.com/Health/aboutrapitup.htm). These types of projects require major funding, however, which could be difficult to obtain, and is a crisis the truth Campaign is currently facing. Another drawback of such operations is that the success is primarily dependent on the procedure of having individuals actively getting tested, whereas anti-tobacco efforts simply require a more personal action of the discontinuation and refusal to smoke cigarettes. Thus is it imperative to devise feasible and appropriate HIV/AIDS treatment and prevention programs be specifically tailored to these high-risk communities. Moreover, some researchers refer to the concept of the “AIDS burnout” or “safer sex fatigue” where individuals are disinclined to adapt to a prolonged behavioral change over an entire lifetime (Ostrow; 2002). Therefore, the key to a successful prevention program is simplicity.

    HIV/AIDS is a worldwide epidemic, but efforts to solve this crisis must begin at home. Understanding who is infected and at risk, where these individuals are located, and how they are contracting the disease allows for the creation suitable prevention programs. The simple distribution of contraceptives and clean needles is the first action. The implementation of HIV/AIDS education in the school systems is also critical, making it necessary to gain federal and state funding in order to teach prevention and its importance. Finally developing organizations in which peers are trained as “down-low” educators involving the church and local community that may preserve a man’s identity as well as endorse HIV/AIDS prevention will provide the most effective anti-AIDS approach for Montgomery County, Maryland.