The main mode of transmission of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in my community is that many men are having sexual relationships with men; thus, it puts us in a quagmire because one cannot restrict somebody to stop having sex. If the city’s major problem was intravenous drug users then a program could be set to have a needle exchange; thus, there would be less of a risk factor. However, in Santa Ana, the problem is that men are having sex with men. People who are drug users will not be specifically targeted because it is only 11 percent of the mode of transmission. Compared to the 71 percent men having sex with men, this amount of people is miniscule. The other problem in Santa Ana is that people do not have adequate income to afford medical care, which would not enable them to get tested or even get some proper treatment. Moreover, because money is such a major issue in the city of Santa Ana, there is has a higher percentage of people who are homeless than in all of Orange County. Since most of them are surviving with a poor income, most of them do not have the means to get treated for any ailments. I am targeting the testing for the homeless because there is no one solution to relieve people of economic dilemmas. I am proposing a service that specifically helps those who are homeless and those who cannot get tested for whatever reasons.

            Nearly 20% (19.846%) of the 337,977 people who reside in Santa Ana live under the poverty line. Furthermore, in all of Orange County, there are about 35,000 people living out in the streets or in shelters (1).  In response to this there are many homeless shelters around Orange County (1). Specifically there are eight established homeless shelters and one in the works in Santa Ana, which include Mercy House, Mary’s Shelter, Grace House and many others. Most of these shelters are for both men and women, or they have two different facilities to house the different sexes. They also provide food, water to bathe in, counseling advice and chapel services. Most of these shelters house the homeless for about two weeks or more until they can survive in society on their own. There’s a story about a Vietnamese single mother who had contracted HIV and was living out of her car. She was referred to Emanuel House, which is one of the homeless shelters in Santa Ana, where she was given help to aid her in regaining the strength that she had lost because of HIV (2). It is these types of programs that are necessary throughout California to help people who are infected with HIV; however, many people do not even know that they have contracted the virus. This is why there should be clinics or a service that allows people to get tested quickly (since some of the residents do not stay there too long) in order to tell if they need assistance or not.

            Probably the quickest way of testing is OraSure/ OraQuick. According to “Saliva-Based Testing among Secondary School Students in Tanzania using the OraQuick Rapid HIV ½ Antibody Assay” in the Annals of the New York Academy of Science it says that OraQuick is easy to collect, and it reduces the chances of accidental injuries(3). It also stated that the testing was a cost-effective alternate to blood testing that took a much longer time to get the results, but is more precise. The way that OraQuick works is that the inside of the mouth is swabbed to collect the saliva. Next the device measures and determines if there are antibodies for HIV. Since it only takes about twenty minutes to get results and requires a drop of blood or oral fluid, it makes it much easier to test people who tend to move a lot. Another benefit from this test is that it costs about forty to fifty dollars per person; thus, it would not cost the government a lot of money. The number might seem high to a few, but if it helps identify patients who are infected with HIV so that they can cease the spread of the disease it will be beneficial.

            These tests would be able to be done at every homeless shelter around the county, but it would not be solely for the homeless. The tests could also be taken by patients who do not have the money to pay for Medicare or any other types of insurance. The service is mainly for those who do not have money to provide for themselves, but it would also be open for people who do not wish for the whole society to know. Usually the homeless shelters are located in places where most people are not aware of. For example a house down the block could be Mercy House, or Emmanuel House, yet one would only know that if one were referred to those houses. Santa Ana is mainly dominated by Hispanics of which include Mexicans, Salvadorians, and a few Guatemalans. Also, many of these families are immigrants, first, or second generation Americans. What this means is that many traditional ways of thinking have “crossed the boarder” and being homosexual or a drug user is an offense of the worst kind; probably as bad murder or stealing. Thus, many Hispanic men who are homosexual act just like the African American “brothers on the down low.” For this same reason, many men do not like to get tested because they do not want to be associated with the homosexual community. However, many choose to say that they are bisexual so that they can be accepted a little bit more than the homosexuals. According to “Sexual Behaviors and Risks Among Bisexually- and Gay Identified Young Latino Men” in AIDS and Behavior many Hispanic youth are confused by their sexuality because they were taught that it was a sin (4). Although supposedly the bisexuals are accepted more they tend to find themselves without support from the gay and heterosexual community (4). Also men, who have relationships with women, but still have romantic feelings for other men, tend to use drugs and alcohol during sexual intercourse with other men (4). Thus, they tend to not use any protection during intercourse, and since these relationships are not monogamous and the men sleep around with many other men, they are at a higher risk of HIV (4). Moreover, many of the men use the internet to look for mates. It is not used to find long term relationships, but to have many one night excursions. The American Journal of Public Health says that many use the internet to find “hard-to-reach” populations that are not easily found on a day to day basis (5). It also says that many of these internet users or at higher risk because they tend not to use condoms during anal intercourse (5). Many of these bisexual guys do not want other people to know their sexual lifestyles, so they won’t get tested for HIV, since it is stereotypically known to be a homosexual disease.  For those reasons, it would benefit all to have testing done at the shelters.

            I am proposing to work specifically with the current seven homeless shelters in Santa Ana: San Miguel Residence I and II, Mercy House (Emmanuel and Regina House), Mary’s Shelter, Laura’s House, and Grace House. There I plan to set up an awareness program and a bi-monthly HIV testing using Oraquick. These institutions house the homeless for at least two weeks so having a doctor come around testing the homeless would be the most efficient way of doing things. The reason why doctors have to specifically be the ones to test the people is because they are the only ones who can order the OraQuick devices. However, it could be possible to have trained nurses rotate around the city to test the impoverished. In order for this operation to be successful, at least two doctors in all of Santa Ana will donate their time to help with this service. Moreover, these would not have to be the same doctors every time and they would not have to go to every single homeless shelter that same day; they would be able to visit them at different times and different days. The only thing that would matter though is that all of the shelters have to be visited by a doctor at least once every two weeks. Also, Santa Ana is not a gigantic city; it is only about seventy-one kilometers squared; Utica is a little over forty-two kilometers squared, so you can see that it is not a major city like Los Angeles that is over 1,290 kilometers squared.

            The second part of this program is to have mandatory classes on AIDS. This class would meet two days, an hour each. In this crash course the people would be taught what HIV/ AIDS is exactly and what are the risk factors that could lead to somebody getting infected. In the Journal of Urban Health there is an article called “Immigration and HIV/ AIDS in the New York Metropolitan Area.” The article states that most of the people that were in their study knew little about HIV; there is even one quote that said “The majority of men associated risk of infection with whether or not they ‘knew’ their sex partner” (6).  This causes a problem because most of the immigrants are more likely to have no health insurance; about one third of the US immigrants have no health insurance and they are the ones who are at most risk (6). The reason to have the classes is to clear up all the misconceptions of how one can obtain HIV/ AIDS and make people aware of the risk of disease. Moreover, by having these mandatory classes, people will be aware of how to stop spreading the virus, which in turn will reduce the amount of AIDS cases. Reducing the AIDS cases is the sole purpose of having this whole program. The other thing that would be done is handing out free condoms at the shelters. This way people will not have an excuse to not practice safe sex, which in turn will reduce the AIDS cases and the spread of HIV. It would be most probable that people that are aware of how the disease is spread and handing out free condoms at the centers would decrease the rate of AIDS cases.

            How will this affect the economy of our government? This will not cost the government anything at all. The way that this testing will occur is that it will be a part of the shelter’s tuition. The way that these shelters work is that you pay the tuition at the end of the program and still be a full participant of the program. This shelter program helps homeless people get jobs and get their lives back on track. The testing costs could be augmented to the tuition that the people to pay at the end. The test only costs between forty and fifty dollars (7). Thus, it would not make a big difference in the tuition since this price could be paid later with the tuition of staying in the shelters. As for the classes, volunteers from the AIDS organization can come and give classes at a specific shelter. The class would occur at Mercy House and members of the other facilities would be required to attend. For those that would not be able to get there on their own, there would be communal vans going to the designated house. The people who want their sexual orientation to be kept out of the public could get tested at the centers, but they would have to pay the full price upfront. As for the mandatory classes, they would have to pay only thirty dollars more to help pay for the services that the shelters and the government are doing. Attending these classes would not necessarily reveal anything about themselves since the people who will attend the classes will include people who are heterosexual, bisexual, and heterosexual. This way they will also be able to participate in the benefits of this program.

            So by having doctors rotating throughout the shelters twice a month to test the homeless and people who are ashamed of their sexual orientation, by using OraQuick, the people will be able to know if they are infected or not. Especially since most do not have the means to get tested on their own. The cost of the program would be included in the overall tuition, which does not have to be paid immediately. Also, the classes and free condoms would make the people more aware of AIDS and how it gets spread so that people will reduce the spread of the disease. Doing this program will not only make people more aware of the disease, but it should reduce the amount of AIDS cases in Santa Ana.

            When I first commenced this course I had not know the degree of how bad the AIDS rate is in Santa Ana. This was caused mainly because there was a lack of information that the media was putting out. After I made some correlations I found out that the average median of income is significantly one of the causes. It turned out that the less amount of money that people made, the more cases of AIDS there would be. Thus, the program that I have set forth will mainly target the homeless because they are mainly the ones who are not earning the sufficient amount of money and who cannot afford to get proper treatment. Hopefully, targeting this group of people will have a beneficial effect in that the amount of AIDS patients will decrease in Santa Ana.

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