Essay

Running Head: FINAL GRANT

Section 1A: Background and NA

The prevalence of HIV infection and how this varies between subgroups is a fundamental indicator of epidemic control. While there has been a rise in the number of HIV diagnoses among Young Men who have Sex with Men (YMSM) of color in America over the last decade, the actual prevalence of HIV and the proportion undiagnosed is not known. We measured these outcomes in a community of Young Men who have Sex with Men (YMSM) of color in America. Findings showed that over one million people aged between 13-29 years of age were living with the Human Immune-deficiency Virus/Acquire Immune Deficiency (HIV/AIDS) disease in the US in the year 2014. YMSM are disproportionately infected with HIV with an average of 40,000 new infections recorded each year when compare to men populations (Centers for Disease Control and Prevention [CDC], 2015). The high number of people who are ignorant about their HIV status continued with unprotected sex increasing the risk levels for other uninfected people in the metropolitan areas among young men who have sex with men (YMSM) of color. More importantly, this group accounted for more than 3800 new diagnoses in the United States in 2015 and was determined to be the largest YMSM subgroup by race/ethnicity, age and sex report (Centers for Disease Control and Prevention (2015). According to the CDC, approximately two percent of men in the United States are Young Men who have Sex with Men (YMSM). The rate of new HIV diagnoses among them is more than 44 times that of other men. In 2015, the CDC determined the rate of Men who have Sex with Men (MSM) range from 522 to 989 per 100,000 MSM, when compared to 12 per 100,000 other men (Centers for Disease Control and Prevention, 2015). There are several reasons that contribute to this increased risk level which include: having unprotected anal sex, substance abuse, social discrimination and cultural issues, lack of access to health care, and lack of knowledge of HIV status.

Participating in unprotected anal sex, or sex without latex or polyurethane condoms is a major risk factor affecting the population. In an infected man, the semen (male sexual fluid) contains high amount of HIV. Semen can pass HIV from one person to another during unprotected anal sex. In addition, the prevalence of alcohol and drug use in YMSM is also quite high, which in turn can increase the risk for acquiring HIV. Several studies link alcohol and drug use to higher rates of unprotected anal intercourse, higher numbers of sex partners, and inconsistent condom use. Because of these trends among YMSM of color Baltimore’s National HIV Behavioral Surveillance (2015) reported 38% YMSM are infected with HIV while 62% YMSM do not know their status. On one hand, substance abuse also increases the risk of contracting HIV. HIV infection is substantially associated with the use of contaminated or used needles to inject heroin.

Lack of access to health care is a barrier to receiving HIV prevention services in the population, particularly for YMSM of color. According to Department of Health and Mental Hygiene (DHMH) Maryland, HIV progress report stated that approximately 80% of YMSM of color in Baltimore City are uninsured (Department of Health and Mental Hygiene, 2015). Also, substance abusers may put themselves at risk for HIV infection by engaging in risky sex behaviors in exchange for powder or crack cocaine.

Socio-cultural factor is another major risk that has held back the 62% of the population that are not diagnosed. Socio-cultural factors such as perceptions and experiences of stigma and discrimination, homophobia, racism, and internalized oppression, may also lead to increased risk of HIV infection in YMSM. Stigma associated with acknowledging homosexual or bisexual activity may inhibit many YMSM of color from identifying as such, potentially leading to denial of their own risk and alienation from prevention programs that target self-identified gay/bisexual populations.

Community Analysis

The community that the organization chose to analyze is young men who have sex with men (YMSM) in Baltimore City in zip code 21201. According to the national data YMSM represent approximately 2% of the US population; however, according to the Center for Disease Control and Prevention, this group is not only critically affected by HIV, but are the only risk group in which new HIV infections have been increasing steadily. (Centers for Disease Control and Prevention, 2016). Young Men who have Sex with Men (YMSM) accounted for more than half (53%) of all new HIV infections in the United States, and men who have sex with men were 44 to 86 times as likely to be diagnosed with HIV compared with other men, and 40 to 77 times as likely as women. (Center for Disease Control and Prevention, 2016). During the same time period when the analysis was conducted by the Centers for Disease Control and Prevention, HIV infections declined by 18 percent among white YMSM (from 9,000 to 7,400 infections), stabilized among black YMSM (about 10,000 infections per year) and increased by 20 percent among Latino YMSM (from 6,100 to 7,300 infections). Of these YMSM groups, black men continue to represent the largest number of new HIV infections (10,000), followed by whites (7,400) and Latinos (7,300). YMSM, between the ages of 13 - 24 years were the most severely affected subpopulation of YMSM.

The most prevalent risk factors among YMSM of color are having unprotected sex, anal sex, lack of access to health care, substance abuse, social discrimination and cultural issues, and lack of knowledge of HIV status. In Baltimore City, Maryland, the population affected by HIV is critically high. In 2015, Baltimore had the second highest rate of reported cases in Maryland, and the sixth highest estimated rate of diagnoses of HIV infection 33.8 per 100,000 population region, compared with other metropolitan statistical areas in the United States. According to Baltimore's National HIV Behavioral Surveillance (2015), the percentage of testing HIV positive among participating YMSM was 38% in 2012 and 2015. (Maryland Department of Health and Mental Hygiene, 2016). Zip code 21201 is one of the most populated area in Baltimore City. It is located approximately one a mile away from Lexington, Mount Vernon and 2.6 miles away from the Charles Village. These areas of Baltimore City composed the largest number of YMSM, by housing hospitals, nightclubs, restaurants, and membership offices.

Primary Data

The primary data was qualitative because collection of primary data is necessary in order to better define the risks and needs in zip code 21201. Primary data was collected through Baltimore City Health Department, Chase Brexton Health Services in December 2015. The statistics estimated that about 6,000 people in Baltimore are living with an AIDS diagnosis, another 13,000 have been identified as having HIV and approximately 2,600 people are infected but do not know it, and majority of those infected and do not know their status; are within the YMSM of color populations (Chase Brexton Health Services, 2015). Collection of data with the Baltimore City Health Department is very important for the sake of accurate data. A visit to the official website of Baltimore City Department of Health provided all the needed data about YMSM of color Community. The data shown that Black YMSM 37.5%, and Hispanic YMSM 4.1%, uninsured among YMSM population Black 70.1%, and Hispanic 10.3%. This organization is working in collaboration with Centers for Disease Control and Prevention to provide accessible health care, medications, and preventive measures to the YMSM population in zip code 21201 Baltimore City. Also, data obtained from Chase Brexton Health Care official website is noteworthy. In December 2015 Chase Brexton Health Care organized a project and the statistics estimated that 6,000 people in Baltimore are living with an AIDS diagnosis, another 13,000 have been identified as having HIV, and approximately 2,600 people are infected but do not know it (Chase Brexton Health Care, 2015).

The organization also got a one on one interview with members of the YMSM at grand central, club 1722 to enable the opportunity of getting first hand data collection with the YMSM of color community; what are the barriers that has made them not to come out and identifying and what are the best way this organization can help their needs. It is useful in obtaining information based on individual insights and feelings. Given the fact that majority of the men who have sex with men of color always have their dealing in zip code 21201 in Baltimore city areas of Lexington, Mount Vernon, or Charles village, it will be easy to engage and talk to YMSM community.

This would include a group of qualified, experienced occupational health professionals that are knowledgeable on the current trends in health and wellness, volunteers, and other focus groups to enable this organization actualized its goals. During this process, data related to the YMSM of color community’s current conditions such as mortality, morbidity and HIV positive/negative rates among YMSM of color will be analyzed. Using primary and secondary data will assist in enlightening the health importance that needs to be addressed and changed within the YMSM of color community.

Secondary Data

When Centers for Disease Control and Prevention (CDC) collected the data 2015, interviewers talk with discoveries to obtain a more comprehensive evaluation of HIV infection among YMSM of color community. Personal satisfaction as a community was evaluated, that is critical to comprehend the wellbeing of the community. Additionally, the accessibility of information for particular subpopulations and sub-country geographies gives structure to recognizing the populaces most helpless against the weakness. In Baltimore City, the YMSM of color and who are HIV, are faced with social discrimination and cultural issues. As a result, many are not willing to opening announce being MSM. The social and economic factors, including homophobia, stigma, and lack of access to health care increase the risk behaviors or discourage participation in HIV prevention services. In Maryland, more than 1,300 adult/adolescent (13+ years of age) HIV cases diagnosed in 2015. By the end of 2015, nearly 32,000 adults/adolescents diagnosed with HIV, landing Maryland 5th among U.S. states in adult/adolescent HIV diagnosis. Baltimore-Columbia-Towson Metropolitan Statistical Area (MSA) had the 10th highest estimated HIV diagnosis rate of any major metropolitan area in the U.S., per 100,000 population.  Before 2016, according to the CDC, nearly 1.3 million adults/adolescents living with HIV in the U.S. and 13percent were undiagnosed. In Maryland, the CDC estimated that 16percent of people living with HIV were undiagnosed (Centers for Disease Control and Prevention, 2015).

1B-Statement of Purpose

The purpose of this Funding Opportunity Announcement (FOA) is to increase the percentage of YMSM of color and YTG persons of color with diagnosed HIV infection who are virally suppressed, reduce HIV incidence among YMSM of color and YTG persons of color, reduce the death rate among YMSM of color and YTG persons of color with diagnosed HIV infection, and reduce HIV-related disparities in incidence, morbidity, and viral suppression among YMSM of color and YTG persons of color.

1C Work Plan/Implementation Plan

The Health Belief model is a model that addresses community perceptions and its relation to initiating behavior change. The stronger the individual's health belief, the greater the likelihood of adopting the healthy behavior. With HIV infected population this model will be effective to utilize for the program. There are several factors that must be addressed within the model in order to drive change in behavior. Some persons’ seeming predisposition forms a personal opinion and sensitivity of being infected with HIV virus due to unprotected sex and other vices that leads to the spread of HV virus. In the United States, MSM accounted for more than half 53% of new HIV infections, and men who have sex with men were 44 to 86 times as likely to be diagnosed with compared with other men ( Centers for Disease Control and Prevention, 2016).

This is important because YMSM of color still engage unprotected sexual conducts with in that population, have elevated social discrimination and cultural issues, and lack of access to health care in the population. These risk factors can not only have a big impact on the lives of the YMSM of color, but also the lager society as well. Actuality infected with HIV can be associated with stigma and discrimination, homophobia, racism, and internalized oppression. Similarly, perceived severity addresses the elimination or reduction of unhealthy behavior among YMSM individuals. Perceived severity is when an individual is convinced that the aspects of some undesirable outcomes is due to the positive HIV status. More specifically, it refers to whether the YMSM of color believe the consequence of having unprotected sex is serious. Things to consider are whether the seriousness outweighs being healthy and there are other things to worry about than their health. The issue is severe enough to possibly avoid. Perceived susceptibility and perceived severity emphasize those individuals who identify a health problem as serious as HIV more likely to engage in a protective sex to prevent the contact of HIV. Perceived benefits ensures that the individual avoid any activity that will lead to HIV infection, such as having protected sex by use of condoms, and avoid contact with body fluid of HIV infected persons. It is often believed that individuals will carry out a health related action or engage in a recommended act if there is a good anticipation that it will reduce or avoid the negative health condition.

Therefore, YMSM of color health can improve by changing the issue. YMSM of color population may exhibit better protective sexual conducts if well informed and educated. Implementing safety sex measures and promotion protective sexual conducts can prevent HIV spread and infections, and also improving health and overall well-being. YMSM of color can adopt a behavior if they believe the new behavior will decrease their chance of contracting HIV. There might be some noticeable barriers in effecting HIV campaigns in the communities, such as the inability of certain folks to accept the call to action. For YMSM of color population inadequate lack of access to health care and social discrimination and cultural issues can be barriers. These barriers can potentially get in the way of things, causing a likelihood of discontinuation in the recommended behavior change. Lastly, with the cues to action mandate, informational brochures will be largely spread in the community and team leaders will be sensitized in follow-up activities. With YMSM of color, this may include preventive sex education and news of HIV/AIDS related cases in United States and other parts of the world. This can trigger a response to act upon the recommended action. An important concept addressed is self-efficacy, which is one’s belief in the capacity to accomplish an assignment such as providing much needed coaching and direction to the participants and facilitators. Their belief in their own abilities can play a major role in making them engage in protective sex. This can be achieved through extensive training and guidance by government agencies, organizations, and focus groups.

The Diffusion of Innovation Theory concentrates on how an innovation spreads through a community. The program wants to addresses the gap between having knowledge protective sex and the need and the importance of living protective life style among YMSM of color. The more people adopt a new behavior, the more likely it can spread throughout a network of people. There are various attributes of an innovation that must be addressed. Relative advantage, the degree to which an innovation is perceived to be better than the idea it supersedes, can be applied to the use of protective sex practices (Glanz, Karen & Rimer, Barbara K., 1997). Using condom and other protective majors is better than exposing oneself to HIV infection.

The greater the perceived relative advantage of using a protective majors among YMSM of color, the faster its rate of adoption is likely to be. Another attribute is compatibility, which is the consistency of the innovation with existing values, experiences, and needs of potential adopters (Glanz, Karen & Rimer, Barbara K., 1997). People wear condoms while having sex for protections, therefore, the existing values of using condom as a protection is major and should be consistent. The next attribute is complexity, which is the degree to which an innovation is perceived as difficult to understand or use (Glanz, Karen & Rimer, Barbara K., 1997). The use of condom as a protective majors is not hard to understand or use. Due to the fact that is not complex to understand or use, it is easy for potential adopters to incorporate it in their daily sex life. Not much time is needed to learn how to use condom to protect against sexual transmitted diseases (STD’s). With regards to safe sex, condoms are often sold in every neighborhood and most times distributed free by government agencies, organizations, and focus groups. Hence, the health behavior is more certain to those who are considering adopting such behavior. Lastly, observability is the degree to which the results of an innovation are visible to others (Glanz, Karen & Rimer, Barbara K., 1997).

Within the YMSM of color the applying a protective majors of sexual practices by some can influence others and it will become visible to them. The easier it is for individuals to actually see the results of a healthy behavior, the more likely they are to adopt it. The more people apply protective majors before or during sex, the more other people will realize the importance of having a protective sex and hence change their behaviors. It is by changing behaviors within the YMSM of color community that an adopted behavior can spread throughout YMSM of color population.

The goal of outreach is to build a relationship with the potential participant, therefore, the content of each contact is not prescribed.  Experience indicates that an excellent way to build rapport is to provide information/materials perceived to be useful by the potential participant.  Therefore, street level contacts will often include short and clear HIV prevention education messages, distribution of free condoms and informational brochures and referrals to community resources for various needs. Outreach teams will each be issued with a phone and will use this to make referrals as needs or as identified.

The program focuses on reducing the prevalence spread of HIV among YMSM of color. There have been some successful programs in the past that helped with reduced HIV spread with prevention and control that involved the Centers for Disease Control and Prevention team. The main focus of the program is improvement; therefore it will improve upon the existing efforts made by various programs. The program deals with improving upon prevention measures and including HIV reduction activities. The prevention program will implement activities within different YMSM of color communities to help educate or manage the spread of HIV. In addition, a group of healthcare professionals or focus groups that are well knowledgeable on the current trends in health and wellness, will educate a safe preventive majors to cut down the spread of HIV among YMSM of color. The health care professionals will be available to answer any questions or concerns that the YMSM of color community may have.

Grant Goal: Reduce HIV incidence among YMSM of color and YTG persons of color, Increase the percentage of YMSM of color and YTG persons of color with diagnosed HIV infection who are virally suppressed, Reduce the death rate among YMSM of color and YTG persons of color with diagnosed HIV infection, and Reduce HIV-related disparities in incidence, morbidity, and viral suppression among YMSM of color and YTG persons of color.

Goal related to your community: In the community providing access to comprehensive health care services, targeted HIV testing, and provide comprehensive health education on prevention and need for protective sex zip code 21201 in Baltimore City.

1D-Evaluation Plan

The key is to consider summative evaluation as a way to gauge, at a particular point in time, student learning in respect to substance norms. In spite of the fact that the data that is gathered from this sort of appraisal is critical, it can help in assessing some areas of the HIV preventive procedure. Since they are spread out and happen after guideline at regular intervals, day to day, summative assessment are devices to assess the adequacy of projects, HIV preventive change objectives, an arrangement of preventive programs, or take study of spread, treatment, and the prevention in particular projects. Summative happen too far down the learning way to give data at the general setting and to make instructional conformities amid the learning procedure. For example, in community setting in zip code 21201 in Baltimore City.

At the point when fused into community practice, formative assessment gives data expected to change the community understanding about HIV and help them learning while they are still up to the minute. The procedure serves as practice for the government agencies and a check for comprehension amid the HIV preventive process. The developmental appraisal prepares guides government agencies in settling on programs and preventive methods for the future direction.

Community exchanges can inform government agencies, organization, program coordinators much regarding the preventive methods apply and knowledge of essential ideas. The government agencies like CDC can start the course by giving organization strategies on certain preventive methods. The objective is to construct HIV preventive strategies that help create necessary and inspired abilities to fight the HIV virus. Exchanges permit organizations to build the expansiveness and insight of their comprehension while setting of wrong HIV data and growing and illuminating foundation Prevention. By enacting organizations as learning assets for each other, there is the likelihood of a portion of the biggest additions found in any instructive mediation. The government agency can evaluate organization understanding by listening to the program coordinator reactions and by looking at the blueprint strategies.

Because participating in small group sessions means time away from making money, our program has found that incentives are crucial to gain participation by clients.  The following incentive structure has proven successful in other projects.  Each client who is tested for HIV is given $10, either in cash or in the form of a food voucher.  Each client who returns for results is given another $10 dollars. Refreshments are provided at small groups.  In addition, a $25 dollars door prize (either cash or voucher) is given to one participant or client at the end of the session.  This ensures that clients remain for the entire session and complete the post-test.

2A-Capacity and Organizational Support

The health educator provides ongoing technical assistance to organization staff on strategic planning, evaluation, coalition building and fund development.  Staff will consult the direction and the health educator on ways to improve the coalition and methods for sustaining the coalition after the project ends. By its nature, community level outreach on HIV is a high stress work.  Outreach workers will develop bonds with participants or clients who may be diagnosed HIV positive at any time, and with the help of the social worker the organization will be able to work with the participants or clients on the emotional issues.

As the preventive method and treatment of HIV infection stay high the cost for essential items modification grantees are likewise constrained in the utilization of system dollars to cover a large number of managerial expenses. These costs, which are generally on the rise, include:

• Equipment- This are testing kits, forceps, and other medical Martials for administering any medical duty at the outreach centers.

• Hospital- Accept referrals and provide early intervention services and short-term medical treatment for Coalition clients who test positive for HIV. Document referrals received from the coalition and provide a monthly memorandum to outreach coordinator (Health Educator).

• Energy costs - warming/cooling, sterilization packs, dialkyl quats to avoid contamination.

• Government Health Insurance- Government medical coverage (Medicaid) are difficult to get with HIV infected persons and the private insurance mare on a steady rise.

• Capital costs - including transports, real office hardware, utilities, working, and keeping up structures.

Hence, we have a strong relationship with the community leaders in zip code 21201 Baltimore City, hospital, coalition groups and have talk to number of people who really needs help when it comes to HIV prevention and treatment. YMSM of color community in zip code 21201 are very friendly and easygoing community. Therefore, we hope to help them with our program that we are going to set up there. Our organization have established relationship with other organization that would be involved in this program such as International Red Cross and Red Crescent Societies. These organization has similar outreach programs here in United States and part of the world helping with prevention strategist and supplement medications of HIV treatment. They may act as the outreach centers leaders and as the members in the system. There are a few age bunches. There are a few idiosyncrasies in the educational programs arrangement in each of the gatherings. The staff in the Childhood Program goes about as accomplices to guardians who take a dynamic part in the instructional procedure of their kids. The team incorporates the instructors as well as different experts, for example, a dialect discourse advisor and physical preparing teachers. The guardians are welcome to wind up Head Start volunteers with a specific end goal to take in more about the improvement of their children and to raise their fearlessness.

We have establish contact with Chase Brexton Health Care Services within zip code 21201 community in Baltimore City and they are willing to work with our organization and set up our program; that will provide prevention, treatments, and reduce the spread of HIV infection. Our philosophy is by giving life back to people that illness and stigmatization of their illness has taking away. In this manner, we endeavor to guarantee that all YMSM of color community in 21201 in Baltimore City have the opportunity to healthy life style and also being themselves entirely of their abilities without stigmatization. Consequently, we strive on open door policy strategy, which ensures opportunities for all YMSM of color.