Agency Visit and Community Health Promotion Plan Proposal

Many people are living with HIV in the United States. A high percentage of them live in Maryland. Some of those live in Prince George’s County, where the community of Largo is located. Since awareness about the prevalence of HIV infected people in the area became known, many agencies have located in Prince George’s County or have established organizations there. One such non-profit organization is Heart to Hand. They offer a wide range of HIV-related services to people who think they may be infected with HIV and to those who have a positive diagnosis. With the advancement of knowledge about how HIV is transmitted and contained within the human body, organizations like Heart to Hand are necessary and beneficial to the community of Largo, where it is located. Heart to Hand offers a wide range of services including HIV testing. They offer both traditional testing, which includes at least a week waiting time and point-of-service (POS) results which take about 20 minutes. Because of the HIV testing that Heart to Hand does and its many other services, it is an organization recognized for actively working to slow and stop HIV/AIDS from claiming any more lives.

Description of Agency

Heart to Hand, Inc. is a non-profit organization located in Prince George’s County, Maryland. Its purpose is to empower communities of color through modeling healthcare systems that promote and support health and wellness. Heart to Hand came into being in 1998 because two concerned African American women wanted to give a voice to those living with HIV/AIDS. The disease was spreading throughout the Largo, Maryland community and beyond. What concerned these women, one of them Anne Wiseman, a licensed clinical professional counselor and the deputy director of Heart to Hand, was that heterosexual women were contracting HIV at an alarming rate. This is still occurring. However, Heart to Hand offers many services to help women and others who suspect they may have HIV and those who already have a diagnosis.

In 2013, the Institute for Public Health in Maryland (IPHI) and Heart to Hand established a partnership to improve outreach to community members especially those with HIV/AIDS. They wanted to ensure that all HIV positive individuals were aware of their status and were receiving medical care and other support services for it. One aspect of the care that Heart to Hand and IPHI offer is HIV testing because it is important that one know their status. Heart to Hand has become a home base for many of the IPHI workers in Largo. This collaboration between IPHI and Heart to Hand grew to other institutions as well. Now there are several other health partners involved in the initiative including Greater Baden Medical Services, Dimensions Health System, and the Prince George’s County Health Department. The initiatives are funded by AIDS United, Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation , MAC AIDS Fund, and Washington AIDS Partnership (Wiseman, 2019). These funding sources help to pay for the HIV testing and other services that Heart to Hand offer.

Impact of Agency on Population

It is difficult to quantify the impact that Heart to Hand has on those living with HIV/AIDS in St. George’s County, Maryland. They offer counseling and referrals to other agencies with which they partner to people who live with HIV/AIDS. Wiseman is a counselor as are several others on staff. With the many partnerships that Heart to Hand has fostered, the referral process for people needing assistance with medical issues, social services, housing assistance or mental health issues is efficient and expedient. One initiative in which Heart to Hand was involved was called Total Health Partners (THP) which operated between 2012 and 2015. The Institute for Public Health Innovation (2019) says THP was specifically for Prince George’s County. It combined two projects: one was a link to care project funded by Kaiser Permanente and the other was a retention in care project funded by AIDS United, M.A.C. AIDS Fund and Washington AIDS Partnership (Institute for Public Health Innovation, 2019). These two combined projects advocated testing for HIV and Heart to Hand still offers this vital service.

Wiseman offered an example to illustrate how Heart to Hand works at the community level: a young man who was unsure of his HIV came to Heart to Hand. He was tested and the test came back positive. A few days later, he returned to Heart to Hand because his family had kicked him out of their home. He claims he contracted HIV from a heterosexual encounter, but his family thinks he must be gay. They also suggested that he may be an intravenous drug user, both of which the man denies. Heart to Hand helped him to find housing, provided counseling, and referred him to specialists who can help him to adjust to living with HIV (Wiseman, 2019). This is what Heart to Hand does at the individual level. They also are involved in projects like THP.

Identified Community Need

Prince George’s County, Maryland has a high prevalence of HIV/AIDS, and the infection rate has increased dramatically since 2011. The Maryland Department of Health (2019) says that 994 people in the state were diagnosed with HIV in 2018. At the end of 2018, 31,559 residents of Maryland were living with HIV. Maryland is ranked fifth in the United States for HIV diagnosis rates (Maryland Department of Health, 2019). To put these numbers in perspective, the Center for Disease Control and Prevention (CDC) (2019) says, “At the end of 2016, an estimated 1.1 million people aged 13 and older had HIV infection in the United States, including an estimated 162,500 (14%) people whose infections had not been diagnosed” (CDC, 2019). This is why getting tested is so important. However, many people do not know where to get tested and are afraid of what the results might be.

The CDC (2015) ranked Maryland seventh in the United States for HIV diagnoses in 2015. The CDC has funded the Maryland State Health Department and local health departments to implement programs and policies that will impact HIV prevention efforts. This funding “supports evidence-based disease monitoring, service delivery, staff development, routine program evaluation, and HIV prevention work” (CDC, 2015). Whether Heart to Hand is one of the agencies funded with CDC dollars is unclear, but it seems likely that Heart to Hand has benefited from the funding and has used it to reach out to more people in Prince George’s County who are living with HIV/AIDS especially those who have not yet been diagnosed.

Despite that type of federal funding that is dispersed throughout various agencies working to fight HIV/AIDS, more funding and resources are needed to combat the growing numbers of people being diagnosed with HIV in Prince George’s County and specifically in Largo. Heart to Hand provides many services to the community including HIV testing, health education, and health literacy about HIV. They also offer counseling and referrals to other agencies as needed. They see how serious the spread of HIV has become in Prince George’s County, and they are doing all that they can to identify it and prevent it. Besides Heart to Hand, there are other non-profit groups working to prevent the spread of HIV in Maryland. All of them need more funding and the way to get that is to promote them—spread the word about the good work they are doing and persuade people to donate to them. Nurses can advocate for such groups through referrals, volunteering, and contacting professional nursing organizations to get them on board. As a political entity, nurses can advocate for more funding for non-profits like Heart to Hand.

Epidemiology of the Community

In 2017, Prince George’s County, Maryland was second only to Baltimore City in prevalence rate of HIV in Maryland according to County Health Rankings (2019). While the data used is somewhat dated, the ranking of second to the largest metropolitan area in the state does not bode well for Prince George’s County. The most recent epidemiological information from Prince George’s County government (2010) say that African Americans are the majority of new HIV/AIDS cases reported at 86.5%. Hispanics account for 4.7% of HIV/AIDS cases and white people for 6.6% of reported cases. This is in line with the statistics for the United States. As of 2010 in Prince George’s County, there were approximately 5,500 people living with HIV. Males are nearly twice as likely to contract HIV as females (62.1% and 37.9% respectively). This is also the case in Prince George’s County. The age groups of people living with HIV in Prince George’s County are as follows: age 40-49 represent 35.7%, age 30-39 represent 23.4%, age 50-59 represent 20.6%, and the remaining percentages are those under the age of 30 for the most part. However, HIV diagnoses have demonstrated an increasing trend in the age group under 20 and over 50. However, it is decreasing in other age groups or remaining stable in recent years. Heterosexual exposure accounts for 44% of HIV transmission, men who have sex with men accounts for 36.8% and intravenous drug use accounts for 14.6% of reported HIV cases. Approximately 84% of transmission of the HIV virus is through sexual contact (Health Department, Prince George's County, 2010). Those who have had sexual contact and may fear that they have contracted HIV can contact organizations like Heart to Hand for advice and assistance.

Literature Review

When the Affordable Care Act (ACA) became law, many things changed for those living with HIV. Rather than viewing the disease through the lens of judgmental stigmatism, money was dedicated to studying the disease and trying to find a cure. Greenberg, Purcell, Gordon, Barasky, and del Rio (2015) of the Journal of Acquired Immune Deficiency Syndromes explain that because of ACA funding, the focus became “decreasing new HIV infections, improving access to and outcomes from HIV care, reducing disparities, and increasing coordination across the various levels of government responsible for funding research, prevention, and care” (Greenberg, Purcell, Gordon, Barasky, & del Rio, 2015, p. 2). Federal agencies shifted their focus from avoidance to reducing the number of people with HIV who are undiagnosed and ignorantly spreading the disease to others. Another focus was getting care for those who are diagnosed and keeping them in care so that they can benefit from the new HIV medications that make it possible to achieve viral suppression (Greenberg, Purcell, Gordon, Barasky, & del Rio, 2015, p. 2). Many people live with HIV and may not even register that they have the disease because of the advances in medical science that has resulted in medications that suppress the virus and allow people to live normal lives even though they are technically HIV positive. Because according to (Keller, Jones, and Erbelding (2011) of AIDS Patient Care and STDs, “Once aware of their serostatus, HIV-positive individuals decrease HIV-related risk behaviors such as unprotected vaginal and anal intercourse” (Keller, Jones, & Erbelding, 2011, p. 237).

This means that simply by getting people tested, there is less chance of the disease continuing to spread.

Most people who discover they have HIV learn it by having a blood test. Until recently, if one had a blood test for HIV, they had to wait for a week or so to get the results. That anxiety filled week is difficult to live through, so researchers found a way to test for HIV almost immediately. Now, it turns out, some people would rather spend the anxiety filled week waiting. Keller, Jones and Erbelding (2011) say, “Between 20% and 59% of those who test positive in STI clinics fail to receive their results. Studies in some clinics showed that more clients learn their test results with point-of-service (POS) testing than with conventional testing” (Keller, Jones, & Erbelding, 2011, p. 237). The benefit of POS testing is that it offers the results in 20 minutes. Those 20 minutes may be anxiety ridden, but it is better than a week of not knowing. People who are at the highest risk for HIV would benefit most from POS testing, but Keller, Jones and Erbelding (2011) found that over half of all those who were tested preferred to wait for the conventional testing (Keller, Jones, & Erbelding, 2011, p. 240). One group that had low testing rates were those who used intravenous drugs according to Spiller, et al. (2015) of the MMWR: Morbidity and Mortality Weekly Report. However, those who had health insurance were more likely to get tested (Spiller, et al., 2015, p. 271). This illustrates the benefits of the ACA to those not yet diagnosed with HIV and those who have.

Community Resources

Besides Heart and Hand and the other agencies listed above with whom they are affiliated there are several agencies working in Maryland and Prince George’s County. Because of its high prevalence of HIV, many agencies opened branches or reached out to Prince George’s County. The CDC, the AIDS Project, and many others who are concerned with the spread of HIV, and those agencies and organizations who located near or send help in the form of funding and support because of the new initiatives through the ACA. Heart to Hand has been around longer than many of these organizations, and has another focus as well. However, they have found that stopping the spread of HIV also helps women of color, which was their initial focus.

Recommendations

The sources available in Prince George’s County are numerous. Perhaps the way nurses can help is to volunteer to do the HIV testing, or just to work in agencies such as Heart to Hand. Encouraging patients to get tested for HIV, especially if they are in high-risk groups is also something nurses can do to help stop HIV/AIDS. Once a person gets an HIV diagnosis, s/he can start treatment and prevent it from becoming full blown AIDS. Nurses can educate their patients about this and they can refer them to organizations such as Heart to Hand.

References

CDC. (2015). Maryland State Health Profile. Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/nchhstp/st...

CDC. (2019, April 12). HIV Surveillance Report. Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/hiv/statis...

County Health Rankings. (2019). Prince George's County. Retrieved from County Health Rankings: https://www.countyhealthrankin...

Greenberg, A. E., Purcell, D. W., Gordon, C. M., Barasky, R. J., & del Rio, C. (2015). Addressing the challenges of the HIV continuum of care in high-prevalence cities in the United States. Journal of acquired immune deficiency syndromes (1999), 69 Suppl. Journal of Acquired Immune Deficiency Syndromes, 69(S1), 1-14. Retrieved from https://www.ncbi.nlm.nih.gov/p...

Health Department, Prince George's County. (2010, September 10). Statistics, Trends and Prevention Messages: HIV/AIDS. Retrieved from Health Department, Prince George's County: https://www.princegeorgescount...

Institute for Public Health Innovation. (2019). Total Health Partners. Retrieved from Institute for Public Health Innovation: https://www.institutephi.org/o...

Keller, S., Jones, J., & Erbelding, E. (2011). Choice of rapid HIV testing and entrance into care in Baltimore city sexually transmitted infections clinics. AIDS Patient Care and STDs, 25(4), 237-243. Retrieved from http://content.ebscohost.com/C...

Maryland Department of Health. (2019). Quick Maryland HIV Statistics. Retrieved from Maryland Department of Health: https://phpa.health.maryland.g...

Spiller, M. W., Broz, D., Wejnert, C., Nerlander, L., Paz-Bailey, G., (CDC), C. f., & Group, N. H. (2015). HIV infection and HIV-associated behaviors among persons who inject drugs--20 cities, United States, 2012. MMWR: Morbidity and Mortality Weekly Report, 65(10), 270-275. Retrieved from https://www.ncbi.nlm.nih.gov/p...

Wiseman, A. (2019, September 18). Heart to Hand. (Millicent, Interviewer)