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Preventing the Spread of HIV/AIDS through

Prevention-Focused Education
Alexis J. Holwerda
Leonardtown High School


Since its inception in the 1980s, human immunodeficiency virus / acquired immunodeficiency
syndrome (HIV/AIDS) has spread throughout both developed and underdeveloped parts of the
world. Therapy and treatment exists for HIV/AIDS in the form of antiretroviral therapy.
However, this treatment option can be expensive and severely limited in underdeveloped
countries, such as those in Sub-Saharan Africa. A much cheaper and more accessible option to
treat HIV/AIDS is preventative education. Teaching both children and adults about the risks and
treatment options associated with HIV/AIDS will help to lower the rates of HIV/AIDS in the
regions where it is implemented. Focusing on Sub-Saharan Africa, where over half of the global
population of HIV/AIDS sufferers reside (UNAIDS, 2015), education is a viable option which
has the ability to reach villages and cities alike. On a smaller scale, HIV/AIDS in Maryland, and
St. Marys County, is rising (AIDSVu, 2013). Through a service project and internship with the
St. Marys County Health Department, my goal is to help in lowering the growth rate of the
disease within St. Marys County through the use of preventative education.
Keywords: human immunodeficiency virus / acquired immunodeficiency syndrome,
HIV/AIDS, prevention, education, Sub-Saharan Africa, Maryland


Human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS)

was first documented in 1980, with 31 mystery deaths in the United States all sharing similar
symptoms. It was not until 1986 that the virus was given the name of acquired
immunodeficiency syndrome, or AIDS (Cefrey, 2001, p. 10). The Reagan administration poorly
handled the outbreak of infected people. At the time, HIV/AIDS was primarily spreading in the
homosexual community and went by the name of Gay Related Immunodeficiency Disorder, or
GRID. As seen in the short film, When AIDS Was Funny (Calonico, 2015), the Reagan
administration repeatedly disregarded the issue. They assumed it was affecting the homosexual
community, and was not worth the time or money to be a concern, as told by the House Speaker
Larry Speakes (LoGuirato, 2013). This mindset continued for many years, until the malady
infiltrated the heterosexual community. By 1995, most scientists had concluded that HIV is the
non-fatal virus that causes the fatal immunodeficiency, AIDS (Some scientists ask, does HIV
cause AIDS, 1995). The virus reduces the effectiveness of the immune system, making those
infected more susceptible to other diseases, and typically leads to death (Hiv/aids, 2010, p. 2).
Preventative educational measures are not usually taken for HIV/AIDS, as it can be
managed with medication; however, access to the high-tech medication that lowers the risk of
HIV/AIDS infection and transmission is not available worldwide (UNAIDS, 2014). While many
afflicted with HIV/AIDS in the United States are able to access medication, the number of
infected people without access globally far outnumbers those with access. For instance, most
African nations, where the virus is most commonly associated, lack the fundamental treatments.
The economic status of these countries plays a nonexistent role as to whether the treatment is
accessible or not. For example, Nigeria, one of the richest countries in Africa, with the highest
Gross Domestic Product according to the World Bank in 2015, also has some of the highest rates


of HIV/AIDS infections and related deaths (Harding, 2016). According to Fineberg, Mann, and
Sepulveda (1992, p. 20), a seldom used, less expensive route to halt the increasing spread of
HIV/AIDS exists: educating people about how to avoid the risks associated with HIV/AIDS.
HIV/AIDS as a Global Problem
HIV/AIDS transcends borders and is not solely a United States problem; it threatens
every country. In 2014, over 36 million people worldwide were living with HIV. Each year two
million people will become infected with HIV. According to the Joint United Nations Programme
on HIV/AIDS (UNAIDS) (2014), among the infected, only 15 million are using antiretroviral
therapy to combat the disease. This method is accepted as effective, but it is expensive and
limited in accessibility for the majority of HIV/AIDS sufferers. While a majority of HIV/AIDS
infections do occur in Africa, around 24.7 million people are infected with the disease in the
region (AVERT, 2015), the virus is not contained by international borders and has spread
throughout the world. In the United States, more than 1.2 million people are living with
HIV/AIDS. Among these people, around 25% are adolescents. As a result they may unknowingly
pass the disease on to others (UNAIDS, 2014).
Historical Setting
In 1983, the first African case of HIV/AIDS was documented. Eighteen short years later,
in 2001, over 28 million adults and children had become infected with the HIV virus. The
number of infected people in Africa grew much more rapidly than the numbers of their
correlatives in the United States (Essex, Mboup, Kanki, Marlink & Tlou, 2002, p. 200).
However, the largest African populations affected by HIV/AIDS are those in the Sub Saharan
Africa region, who live with a much higher risk of contracting HIV/AIDS as compared to their
North African counterparts. This is due to socioeconomic differences stemming from


imperialism (Byrnes, 2014) between the two regions - North Africa is much more developed,
thus having more access to treatments (Essex et al., 2002, p. 203). In both the Sub Saharan
Africa region and the United States, the issue was not taken as seriously as it should have been
from the onset of the HIV/AIDS epidemic (Richert, 2009). The Reagan administration set the
tone that HIV/AIDS should not be taken as a serious issue in the United States (Richert, 2009).
HIV/AIDS in Sub Saharan Africa. As Sub Saharan Africa is a third world region,
their access to the newest medications and the newest ways to prevent HIV/AIDS is largely
nonexistent. As Fineberg, Mann, and Sepulveda (1992, p. 17) maintain, the often repeated
dictum that education is the most effective weapon to prevent infection remains valid because
diseases never really disappear; they must be controlled through vaccination and education.
When the people of Sub Saharan Africa do not have access to the education they need to learn
to effectively prevent HIV/AIDS, no amount of vaccinations will ever fully eradicate the disease.
In a way, it is comparable to the influenza virus. Most of the world has easy access to the
influenza vaccination, yet the virus still runs rampant every year because without basic disease
prevention, the disease can never be fully eradicated; influenza prevention comes in the form of
educating children and adults about the proper way to sneeze, cough, and wash their hands.
(Fineberg et al., 1992, p. 50).
HIV/AIDS in the United States. HIV/AIDS in the United States is comparable to that of
Sub Saharan Africa despite the obvious differences between the two regions. The Center for
Disease Control (the CDC), the United States governmental agency that monitors the spread and
prevention of infectious diseases, estimates that over 1.2 million people over the age of 13 are
living with HIV in the United States. Among those infected, over 12% (about 156,000) do not
know they are living with the infection. These uninformed Americans run the serious risk of


unknowingly passing on the disease through unprotected sex, intravenous drug use, and other
means of sharing of bodily fluids. Being uninformed and unknowingly passing on the virus may
explain the 50,000 new cases of HIV in the United States every year (CDC, 2015). As proposed
by Lewis (2001) in Current Sociology, if these infected people, and their uninfected counterparts,
had more opportunities to be educated about the disease then the rate of HIV/AIDS infection
would slow dramatically due to knowledge of prevention (p. 2).
The Reagan Administration and its role at the dawn of the HIV/AIDS crisis. The
Reagan Administration was ineffective in handling the outbreak of HIV/AIDS in the United
States. The clearest example of this can be found in When AIDS Was Funny and in the
commentary provided by the representative of the Administration, Larry Speakes, at press
conferences. President Reagan failed to acknowledge the existence of HIV/AIDS until his close
friend, Rock Hudson, became fatally infected (Richert, 2009). The Reagan Administration failed
to provide any guidance to the citizens of the United States amid the crisis and allowed the
pressure on the situation to rise.
San Francisco, the true ground zero (Weissman, 2011) for the epidemic in the United
States, was one of the first United States cities to handle the gay plague (Weissman, 2011).
The city utilized the activism and progressivism that came from the Civil Rights Era in the
1960s, known as the San Francisco Model (Weissman, 2011). As a whole, the homosexual
community combated homophobia in the United States, and its purposefully ignorant
government, and fought against the lack of universal healthcare offered. The San Francisco
model remains one of the most commonly used for those seeking to justify a healthier and more
humane society (Weissman, 2011).


Inception and continuation of HIV/AIDS preventative education. The first program to

acknowledge the growing spread of HIV/AIDS and the need for its prevention was the Global
AIDS Strategy. Constructed by the World Health Organization (WHO) in 1986, it evolved into
the Global Program on AIDS by 1987 due to the growing concerns about HIV/AIDS (Fineberg et
al., 1992, p. 23). The three objectives of the Global AIDS Strategy include prevent HIV
transmission, reduce (control) the personal and social impact of HIV/AIDS, and unify national
and international efforts against the disease (Fineberg et al., 1992, 23). In a little over two years,
the Global Program on AIDS was collaborating actively with over 155 countries, through a well
defined and systematic process (Fineberg et al., 1992, p. 23).
Prior to the introduction of the Global Program on AIDS, many countries, including the
United States and most Sub Saharan African states, affected by HIV/AIDS were reluctant to
admit to having the disease within their borders. The image of being infected with HIV/AIDS
was not conducive to international relations, and the countries were trying to work in their best
interest by not acknowledging the problem. However, through the encouragement of the Global
Program on AIDS, these countries were able to develop open and active programs (Fineberg et
al., 1992, p. 24) and admit to the rest of the world that while they were suffering from an
epidemic, they were also working to help their people. As HIV/AIDS initiative programs were
developed throughout the world, by 1989, they primarily focused on perception of HIV/AIDS,
audiences, and channels (Fineberg et al., 1992, p. 26). The primary concern of the programs was
not to find a prevention for the disease and eradicate it, but to encourage countries to accept the
problem affecting their people. This included drawing focus away from perceptions that HIV /
AIDS, including the idea that it is limited to the homosexual community, but instead that it can
affect anyone (Fineberg et al., 1992, p. 28).


Key elements of initiative programs. As outlined by Fineberg et al. (1992, p. 26), the
key elements of initiative programs are perception, audience, and channels. Early on, two major
issues complicated the perception of HIV/AIDS: maintaining a their problem mentality among
those uninfected, and harboring a preconceived prejudice against those infected. In order to
combat resistance to the initiatives, these key issues must be overcome and belong as a part of
the key elements.
Mentality of those uninfected and their perceptions. When the mentality ignoring
problems that are not ones own begins to take shape, there is a smaller chance of taking a stance
against the problem. People not infected with HIV/AIDS are more likely to disregard it in favor
of problems that directly affect them. Without taking a stand against the problem, it can never be
solved (Maticka Tyndale, 2001, p. 14). Without having proper education about HIV/AIDS,
uninfected persons have a growing fear of those infected. By refusing to acknowledge the
problem and the growing number of infected persons, the uninfected persons are inherently
making the situation worse. Global initiative programs are working to educate everyone about
the need to make HIV/AIDS a forefront issue. Maticka Tyndale (2001) accurately describes the
common public response: denial, the average person will suffer from denial that HIV/AIDS will
affect their specific group or that the epidemic will be as detrimental as it is predicted to be (p.
Audience propagated by global initiatives. The audience of the global initiatives can be
anyone from easy to reach target groups, such as school children, but also hard to reach, such
as prostitutes and drug users (Fineberg et al., 1992, p. 26). By knowing who their audience is
global programs can better tailor their information to reach their target group. The long-standing
tradition of HIV/AIDS only affecting certain groups needs to be put to rest. Growing numbers of


women and children, those not traditionally associated with the malady, are contracting
HIV/AIDS. Global initiative audiences are not to be stigmatized or collectivized; the disease
does not discriminate (Maticka Tyndale, 2001, p. 19).
Channel and implementation of global initiatives. The final element is channel. This is
how the program conveys their point. These range from mass media, to local media (including
posters and flyers), to facetoface interactions (Fineberg et at., 1992, p. 27). Generally, all three
forms are combined for maximum output of information; however, the best forms of
communication are the ones that encourage dialogue and learning from the listeners and readers.
In addition, Maticka Tyndale (2001) suggests that a sense of panic is necessary to implement
global initiatives (p. 18). The audience needs to feel as though there is a reason for the initiatives
to take place, and a little bit of panic is the perfect initiative breeding ground.
Major Stakeholders. The stakeholders within the HIV/AIDS crisis include those
infected with HIV/AIDS, governments, the United Nations (UN), advocacy groups, and entire
communities where HIV/AIDS is a growing crisis. Those infected with HIV/AIDS are primary
stakeholders because they are directly affected. The disease is a permanent part of their life, as
there is no cure. They will forever be HIV/AIDS infected, and, in todays society, they are judged
for it (Kalichman, 2006, p. 12).
Governments and their part in the epidemic. Governments play a direct role in
preventative education because many initiatives to educate people are government funded. The
government has to want to help prevent HIV/AIDS in their community, or else they will not put
forth the time and funding needed to implement initiatives created by the international
community (Essex et al., 2002, p. 204).



The United States government carries a large stake in the crisis they must try and right
their wrongs from the Reagan Administration. The U. S. Congress passed the Affordable Care
Act provisions designed to help those suffering from HIV/AIDS get more thorough care and the
necessary medications they need (HHS, 2015). The increase of funding to help those suffering
from HIV/AIDS provides another reason for the United States government to work towards the
eradication of HIV/AIDS: money and funding. The government must allot funding to support the
programs to help those already suffering from the disease. A decline in the disease would mean a
decline in the money the government needs to spend to help those with the disease.
Governments outside of that of the United States also share a stake in the issue. The
Nigerian government, one of the top earning African nations (World Bank, 2016), holds a major
stake (Harding, 2016). Despite their large gross domestic product (GDP) earnings, the also have
some of the highest rates of HIV/AIDS prevalence in Sub Saharan Africa. Pressured by the
international community, the government feels the pressure to work towards a solution, which
takes money. Even though Nigeria may have a relatively high GDP, it is significantly less than
that of the United States, and they cannot handle a continued epidemic. This gives them a stake,
whether they want it or not.
The international community and its involvement. The United Nations (UN), as the
worlds largest intergovernmental organization, is a stakeholder. The UN started their own
initiative, UNAIDS, and put eradicating the spread of HIV/AIDS on their millennium
development goals (MDG) list (UNMDG, 2015). The MDG list consists of the eight most
important issues the UN believes require immediate attention from all governments. The UN
readily invests time and money, along with complying governments, to work internationally to
eradicate the spread of HIV/AIDS. One major facet of the UN is promoting international peace



and cooperation, and this contagion is placing strain on their goals. Countries are looking for
somewhere to place the blame, and subsequently resist collaboration, because they do not want
to accept responsibility (UNAIDS, 2015). By creating a solution that can be applied to many
countries at once, with equal responsibility shared, the UN will be able to return normal levels of
international collaboration (UNAIDS, 2015).
Advocacy groups piece of the crisis. Advocacy groups are major stakeholders and are
the ones who are putting forth private money to fund the prevention of HIV/AIDS. AVERTing
HIV and AIDS (AVERT) provides free programs for people all over the world, speaking all
different languages, to help them get away from the HIV/AIDS crisis in their community.
AVERT is not unique in its initiatives. Hundreds of non-governmental organizations work to
advocate for HIV/AIDS prevention, not only in Sub Saharan Africa, but also throughout the
world. Starting in 1986 at the beginning of the HIV/AIDS crisis, AVERT raises awareness and
educates people about all things HIV/AIDS from preventing mother to child transmission to
treatment as prevention (AVERT, 2015). They primarily work in Sub Saharan Africa to provide
help to those without the economic funds to support their own struggle through HIV/AIDS.
Communities: the first-hand stakeholders. The final major stakeholder includes the
communities within which HIV/AIDS is a growing problem. As HIV/AIDS knows no bounds,
affecting communities located not only within the third world, but also within the most
developed countries, such as the United States and Canada (UNAIDS, 2014). The only way to
prevent the spread of a disease is to raise awareness about its prevention, and this requires
education. Communities have to be willing to put forth the effort to educate their citizens on the
risks of HIV/AIDS and how to minimize the risk.



Communities have to deal not only with economic repercussions, but also with social
impacts. A community with a high prevalence of HIV/AIDS is not going to attract business, and
is likely to lose its citizens. (UNAIDS, 2015). A loss of monetary flow in the community leads to
an economic downfall, and its citizens are likely to fall further into poverty. This only furthers
the cycle of HIV/AIDS because the impoverished citizens are much less likely than their middleclass counterparts to have access to HIV/AIDS treatments (AVERT, 2015). The social impacts
stem from stigmatisms surrounding HIV/AIDS outbreaks. From the beginning, during Reagans
time as president, prejudice and fear encompassed the crisis (Richert, 2009). These feelings only
grow into something much worse, prompting activism comparable to that of the Civil Rights Era
(Weissman, 2011). Communities do not want to have the stigmas and poverty surrounding them,
and thus are invested in a search for a solution to the crisis.
Immediate and Future Effects
If the HIV/AIDS crisis continues at the rate it is right now, then each year two million
more people will be infected, and 1.2 million will die each year because of the disease. Children
will continue to be orphaned due to the epidemic, and families will continue to lose loved ones
(UNAIDS, 2014). These numbers are much too high for such a modern era where medicine and
education have eradicated numerous infectious diseases. Moreover, given the globes
instantaneous means of dispensing and accessing information, there can be no good reason for its
inhabitants not to be exposed to the facts and dangers of HIV/AIDS. Such educational exposure
will surely reduce the deadly exposure of the virus (Fineberg et al., 1992, p. 30).
If the immediate effects of letting the disease run rampant are not taken care of, then the
future effects will only continue to get worse. In the future, the epidemic is not going to fix itself.
An understanding of the future effects can be found from looking into the past. At the inception



of the HIV/AIDS epidemic, the crisis caused a panic. People did not know what was causing it,
or how to stop it; there still is no true cure, only drugs that minimize the side effects and allow
sufferers to live relatively normal lives. The rate of infection has grown exponentially from the
1980s, though, a resurgence of the disease within society. Governments are still ill-equipped to
handle an outbreak of the magnitude that HIV/AIDS is capable of causing. The continuation of
the spread of HIV/AIDS will undoubtedly lead to disastrous results, which will be amplified by
the fright of the general population (Mays, 1989, p. 12).
Difficulty to Resolve
Despite the abundance of knowledge scientists and officials have gained about
HIV/AIDS since its inception in the 1980s, no consensus exists on how the issues of HIV/AIDS
should be solved and who should be held responsible. The main players in resolving the
HIV/AIDS crisis have differing opinions on how to fully resolve the issue. Some believe that it is
up to the international community as a whole, but others believe that individual governments
should be in charge of their own states. The third world governments are more likely to believe
that the international community as a whole should be the main player (Fineberg et al., 1992, p.
30) so they can provide funding for those communities who can not finance solutions on their
own. The more developed countries want to leave initiatives up to the individual governments.
The better approach is a united front within the whole international community. This way, not
only will the costs of developing education strategies be shared, but also the different education
techniques can be adapted for numerous countries (Kalichman, 2006, p. 15).
Not only do countries have differing opinions, there is also the issue related to the origin
of HIV/AIDS educational funding. While the numerous stakeholders have the same general goal
of eradicating HIV/AIDS, not all of the countries have the same amount of time, money, and



human resources to put towards solving the problem. If the resources of both developed and less
developed countries were pooled together, then there would be an adequate amount to go around
(Kalichman, 2006, p. 24). The question is whether or not developed countries are willing to give
up their resources and provide them to an underdeveloped country. This is where institutions
such as UNAIDS can make some difference all of the affected countries contribute to the
program, and all of them receive benefits, its majoritarian politics (Kalichman, 2006, p. 20).
Local Community Need in Maryland
As of 2012, over 31, 000 people in Maryland were living with HIV/AIDS (see Appendix
A). As a part of the United States, Maryland is a highly developed area and, as stated by the
Baltimore Sun (2015), the increasing number of people living with HIV/AIDS is troubling
Local Distribution
Not only does Maryland have a fairly high number of people living with HIV/AIDS as
compared to the rest of the country (AIDSVu, 2013), the spread of the virus is disproportionate
among races. As of 2013, over 75% of people infected with HIV/AIDS in Maryland were
African American. That number drops to less than 16% when in reference to Caucasians
(AIDSVu, 2013). According to the Baltimore Sun (2015), the infection of teens and young adults
has doubled since 2003. Maryland does have an HIV/AIDS crisis on its hand, but the education
to prevent it is not being brought forth full force. Education is an easily accessible prevention
method that can be used in Maryland schools, reaching the young adult population. Without
implementing HIV/AIDS education, Maryland as a whole is failing to educate a generation of
young people that are at risk.
Local Stakeholders



Primarily, the local stakeholders are the people infected with the disease. Similar to the
international level, infected people are dealing with the disease in their daily lives, yet may not
even know that they have it. Another stakeholder is the Maryland Health Department, because
they are in charge of preventing local infectious disease. They need to help in the spread of
education about HIV/AIDS, or else the epidemic is only going to continue to get more serious
(CDC, 2015). Locally, this disease puts everyone in the community at risk. Without proper
education, the citizens of Maryland lack proper awareness of when they are being exposed to
HIV/AIDS, and how to limit their exposure and reduce their risk of contracting the disease. The
community needs to work to prevent the disease such a small community could easily be
ruined by a disease of this magnitude (SMCHD, 2015).
St. Marys County Health Department
I plan to work as an intern with the St. Marys County Health Department (SMCHD) in
order to spread awareness about HIV/AIDS. SMCHD works not only to prevent the spread of
disease, but also to raise awareness about the communicable diseases that easily spread and
infect citizens within the St. Marys County area. Committed to the wellbeing of the community,
the St. Marys County Health Department is responsible for protecting and promoting the health
of our St. Marys County community (SMCHD).
History / Purpose
The SMCHD is a part of the federal Department of Health, an overarching health system
that the Eisenhower Administration founded, which has continued to expand to local
communities (Cropper, 2015). As one local community, the purpose for the founding of the
SMCHD was to educate the Southern Maryland community about possible infectious diseases.
The department has an overarching mission statement, which include the following services:


Informing and empowering residents about public health issues,

Continuing to strengthen community partnerships,

Managing open, efficient, and effective culturally sensitive programs to assure


adequate public health services,

Monitoring health status and developing policies to address public health issues,
maintaining a safe and healthy environment, and

Preparing for and responding to public health emergencies (About our Agency,

Offering these services to the citizens of St. Marys County, the SMCHD is able to limit the
number of communicable disease infections in the community each year.
Population served. The SMCHD serves all the citizens of St. Marys County, Maryland
through providing care clinics and disease testing to all residents, and anyone who comes to their
clinics. Not only do they serve sick citizens, but also they provide awareness to the healthy.
Striving not only to care for the infected, but also for the uninfected, the SMCHD does not
discriminate in their inclusion of citizens for treatment. The SMCHD follows the old adage an
ounce of prevention is worth a pound of cure in order to protect their citizens to the best of their
ability (SMCHD). The SMCHD follows local, state, and federal regulation, in order to inform St.
Marys citizens (CDC / SMCHD, 2016)
Services offered. The SMCHD provides free and paid clinics, classes, and seminars.
They have medical clinics, where county citizens can come and get tested for diseases, such as
sexually transmitted diseases, free of cost. By providing free clinics, the SMCHD has the
potential to reach the whole community, regardless of socioeconomic status. They also provide
classes, where citizens can become educated on certain diseases, preventing them, and how to



treat them. Moreover, classes are offered for all ages, not only adults. Prevention starts from a
young age, and habits that can be applied to everyday life, such as teaching children proper
hygiene, sets a solid foundation for a healthy lifestyle (SMCHD, 2015). By traveling to different
locations within the county providing seminars, the SMCHD brings preventative education to the
people, rather than requiring people to seek out the education. Similar to medical clinics,
seminars are free of cost, eliminating the idea that only certain people can afford to attend them
(About our Agency, 2015).
Benefits of the SMCHD. Without a community service like the SMCHD, St. Marys
would be lacking in its preventative education. The SMCHD provides necessary information to
the public regarding not only current diseases, such as the annual influenza virus (CDC /
SMCHD, 2016), but also diseases that may possibly spread into the area. As of 2016, they are
providing information on HIV/AIDS, Zika, and Ebola, even though Zika and Ebola are not
directly affecting the St. Marys County community. Their website keeps all of their information
current, so at the click of a button, the community can find out what diseases pose a risk.
Role as an Intern
I plan to work as an intern in the department through attending and supporting their
seminars and classes in order to help inform the community about the risks and stigmas
surrounding HIV/AIDS. Specifically, I hope to help run seminar booths and speak to the public
about their conceptions, or misconception, about HIV/AIDS and how they can work to prevent
the disease within their lives and their small communities. This would include being responsible
for distributing information, and public communications. Through my time at the department, I
want to learn what the community believes about HIV/AIDS, and reveal what information may
not be true.



Impact. The short-term impact will be that people who attend the seminar and service I
am helping to provide will walk away with a new outlook on HIV/AIDS. Through more
education, I strive to help provide the citizens of St. Marys County with a desire to take
preventative steps in their own lives, and stop the problem before it starts. In the long run, my
goal is that the people who I impact will spread the word to their own smaller communities, and
information and education about HIV/AIDS will spread throughout all of St. Marys County.
Another impact is to reduce the stigmatisms associated with HIV/AIDS. The problem is easier to
address when the general population does not treat the subject as if it will hurt them to talk about
it. My goal is to get the conversation about HIV/AIDS and its prevention started within the
community, eventually providing easier implementation about preventative education. Due to
increased education, it is my prediction that the rates of HIV/AIDS prevalence will drop within
the community, as more people will be educated and know how to prevent the disease. Evidence
of education as prevention can be found in the Sub Saharan African communities who have
worked to decrease rates of HIV/AIDS infections using education (Fineberg, 1992, p. 20)
Service Action Plan
Through my service with the SMCHD, I seek to impact the community through education
about HIV/AIDS, as well as help to lower the HIV/AIDS infection rates within the community.
As an intern at the SMCHD, I will be given certain responsibilities within their clinics in order to
help serve the community.
Overview of Service
My service will be both direct and advocacy. Directly, I will be impacting the community
through helping in an HIV/AIDS testing clinic, where I will be able to talk to at-risk citizens, and
hopefully help to educate them. Through this, I will also be able to gain a first-hand perspective



of those suffering from the disease within a local community setting. While helping out at the
clinic, I, along with the SMCHD, will be educating those in attendance about the risks associated
with HIV/AIDS, and how to avoid contracting the disease. Free screening clinics are essential to
the community because those at the highest risk often cannot afford to see a doctor on a regular
basis in order to be screened (Prochnow, 2016). In addition to direct service, through advocacy I
will be making a PowerPoint presentation for the SMCHD to use to spread the word about the
risks of HIV/AIDS. The PowerPoint I have been tasked with making during my internship will
be shown not only at the Department building, but also when they travel to clinics, seminars, and
classes (Prochnow, 2016).
Areas of impact. The crux of my project is to use education to prevent the spread of
HIV/AIDS. Through my service, I will be directly informing my local community about the risks
associated with these diseases and the need to know preventative measures. Education about
prevention is greatly lacking in schools, not only in the United States, but also around the world.
On a small scale in St. Marys County, I will be contributing the necessary education associated
with HIV/AIDS prevention (CDC / SMCHD, 2016). In impacting the community, my project
will help to inform citizens and educate citizens of all socioeconomic statuses this will be
possible through the SMCHD. There is no socioeconomic status that denies access to the
SMCHD, and thus I will be able to reach the entirety of my community.
Required Skills and Responsibilities
I will employ certain skills for this service project, including the ability to effectively
utilize PowerPoint, act with a respectful behavior around those in the clinic, and maintain a sense
of responsibility for the community. PowerPoint is a necessary aspect because part of the service
is to create a presentation that the SMCHD will be able to distribute as deemed necessary. I must



be able to effectively communicate the need for education about HIV/AIDS through both writing
and graphics within the PowerPoint. While working in the clinic, respectful behavior is a must.
Without respectful behavior towards those being tested, I would not be representing the SMCHD
or Global and International Studies as they should be represented. A sense of responsibility is
necessary because I must keep in mind that all the work I am putting in is benefitting the
community (Prochnow, 2016). Through this service project, I am a part of something that is
much larger than myself; in remembering this, I will be able to put all of my effort into informing
and education my community and my peers.
Required Resources
In completing this project, I will need access to the clinic, as well as access to the
SMCHD databases and a computer. The clinic involves numerous people in order to be effective,
and I will be working alongside skilled nurses and doctors to help those in my community. For
my work in the SMCHD, the government provides the money that funds the clinic at which I will
work. I plan to use the SMCHDs databases for preventative health, as well as statistics, in order
to create my presentation. Using a computer is a pertinent aspect of the project, but it is a
resource I already have in my possession. Without a computer, not only would I be unable to
access the online databases, but I also would be unable to create a presentation.
At the SMCHD, my main contact is Ms. Terry Gray Prochnow, MSN, MBA, and RN.
Ms. Prochnow is in charge of emergency preparedness and response for public health. In
addition, she is heading the HIV/AIDS clinic with which I will be aiding. Her contact
information is:
Terry Gray Prochnow, MSN, MBA, RN



Division Director
Public Health Preparedness & Response
St. Mary's County Health Department
21580 Peabody Street
PO Box 316
Leonardtown, MD 20659
301-475-4319 (phone)
301-997-5988 (work Cell)
301-475-4308 (fax)
My plan for service includes the following:

March 3, 2016: Meet with Ms. Prochnow to discuss my internship

o Contact: Terry Prochnow
o Location: SMCHD Headquarters

April 18, 2016: Begin going to the SMCHD once per week every other week after school
to research HIV/AIDS and become proficient in how the clinic operates
o Contact: Terry Prochnow
o Location: SMCHD Headquarters

June 1, 2016: Begin creation of presentation in preparation for HIV/AIDS clinic day
o Contact: Terry Prochnow
o Location: Both SMCHD Headquarters and my home



June 15, 2016: Ensure presentation is finalized and send to SMCHD, set up date for
o Contact: Terry Prochnow
o Location: My home

June 27, 2016: HIV/AIDS clinic day

o Contact: Terry Prochnow
o Location: SMCHD Headquarters
Reflection and Analysis
Through working with the SMCHD, I was able to create a distributable presentation on

behalf of the SMCHD. I worked closely with the infectious disease department within the
SMCHD and, within the office setting, was surrounded with the standard protocols for dealing
with various diseases, including HIV/AIDS, leading to a greater understanding of the difficulties
in dealing with the epidemic.
Successes and Struggles With Implementation
The successes of my project came in the form of raising awareness within the infectious
disease department and also gaining knowledge about how the United States government
organizations deal with HIV/AIDS. Problems surrounding HIV/AIDS are often not at the
forefront of the infectious disease department, as they bear the weight of dealing with every
infectious disease outbreak in St. Marys County, from the flu to rabies (Hall, 2016); a multitude
of diseases means one, such as HIV/AIDS, cannot be focused on for a bulk of the time time
must be spread between all of the diseases. Seeing how much work went into each case of an
infectious disease, forced me to realize first-hand why countries such as Nigeria in Sub
Saharan Africa cannot fully deal with their epidemic: they are not staffed and equipped properly.



This gave me invaluable perspective into why HIV/AIDS is such an issue, not only in the United
States but also in Sub Saharan Africa.
Working within the SMCHD was quite different than I expected; one struggle I faced
came in the form of a lack of events in which I could participate. My days at the SMCHD
consisted of helping my mentor with research surrounding HIV/AIDS and synthesizing my
findings into a presentation. At the end of my internship, I presented my work to the infectious
disease department where I was working.
There is a limited amount of data that I am able to immediately collect from this project.
To fully understand the impact, I must compare HIV/AIDS rates in St. Marys County from 2008
(Appendix B) to those in ten and twenty years. The comparison would demonstrate whether the
infection rates of HIV/AIDS have increased, decreased, or remained the same. Ideally, my
projects impact would lead to decreased rates (Hall, 2016) or rates that have remained the same
over ten years, and continued to decrease further over twenty years. It is unlikely to see the
number of people infected with HIV/AIDS significantly dropping over ten years because the
disease is incurable so all those affected must live with it for the rest of their lives. With a lack of
immediate data, it is difficult to judge whether or not my goal of reducing the HIV/AIDS rate of
contraction in St. Marys County has been achieved.
Changes Regarding Future Implementation
Given the opportunity to recreate my project, I would plan events outside of those offered
by the SMCHD. I feel that within the SMCHD I was not given opportunities to reach the public
to the extent that I had hoped. One change would be to hold free informational seminars
throughout the county to inform St. Marys County citizens, beyond those in the SMCHD, about
the risks associated with HIV/AIDS. Through this change, I would have the ability to interview



and survey those in attendance, which would provide some more immediate data. The surveys
would be given once at the beginning and once at the end of each event to track the changes in
knowledge and perception of HIV/AIDS caused by the event.
Effectiveness of the Project
Overall, the project was effective, although not as effective as I feel it could have been. I
achieved my goal of creating a method of reaching out to others about the risks associated with
HIV/AIDS (Hall, 2016) and the vitality of education as a preventative method. Through working
at the SMCHD, I was able to provide the infectious disease department a different perspective,
one of a young adult, on the HIV/AIDS crisis, which allows them to better tailor their efforts to
the young adult target population. In addition, I raised awareness (Hall, 2016) about the
continuing epidemic in Sub Saharan Africa, particularly Nigeria.
The projects effectiveness lends itself to the projects sustainability, and I feel the project
is sustainable. With the impending HIV/AIDS crisis, various governments, including the United
States, are looking for way to prevent the spread of the disease. The SMCHD was very receptive
to the idea that education is vital to slowing or stopping the crisis, and with the dedication of
organizations, like the SMCHD, and individual citizens, like me, the effects of my project will be
Conclusion and Future Advocacy
Beginning in the early 1980s, HIV/AIDS presented itself within third-world, Sub
Saharan African countries, and within the male homosexual community of the United States.
Ignored by governments, the epidemic continued to spread, and the perception surrounding
HIV/AIDS discouraged many at-risk people from being tested. The Reagan Administration
further pushed the epidemic by ridiculing those affected, and refusing to acknowledge the



problem, even when presented the undisputable facts that HIV/AIDS was spreading throughout
the United States. In Sub Saharan Africa, the epidemic was as ignored by the governments as it
was in the United States. Not only was the epidemic ignored, but also the government was not
well equipped to handle thousands of its citizens at a time. This trend continued, compounding
on itself into the present day, creating an impending epidemic. Despite having the top African
GDP, the Nigerian government does not have the organization or the resources to combat the
This issue is not one that can be solved all at once; it will take time, effort, and money.
For my future advocacy, I want to build on what I was unable to accomplish within my
internship. My goal is to hold a series of educational seminars and information nights not only
within the Leonardtown High School community, but also within the St. Marys County
community as a whole. These sessions will entail the distribution of information about
HIV/AIDS as it is affecting St. Marys and Maryland, the United States, and Nigeria. I plan to
host the sessions in a way that involves the audience through educational games and short,
interactive lectures, teaching them about the issues surrounding HIV/AIDS, and ultimately,
educating them about the prevention. My main goal for future advocacy is to educate the local
community. In addition, I would like to get in contact with an HIV/AIDS advocacy group and
raise money to donate to the group, that way I would not only be helping the local community
but also be helping Nigerian communities.
HIV/AIDS is a serious issue that lacks publicity due to the rise of new diseases and
epidemics. This does not mean that it has disappeared, even in well-established countries such as
the United States. The governments and citizens of all countries cannot continue to ignore the
epidemic at hand; it must be met with force in order to one day rid the globe of HIV/AIDS.



About Our Agency - Saint Mary's County Health Department. (2015). Retrieved February 21,
2016, from
This is webpage is straight from the SMCHD. It outlines their values and their
organization goals. There is information on how the department works, as well as what
they are trying to achieve in the future. It has credibility because it is from the
organization itself, and the national health department backs the SMCHD.
AIDSVu. (2013). Maryland - AIDSVu. Retrieved May 17, 2016, from
AIDSVu is a national organization that is working to increase awareness about the
HIV/AIDS crisis. Their statistics come from government databases, so they come from a
reliable source. The website had helpful info graphics, which allowed me to provide a
visual for my reader about the statistics, instead of just showing numbers.
AVERT. (2015). HIV prevention programming | AVERT. Retrieved January 19, 2016, from
This website is an advocacy group. It has been a part of preventing the HIV/AIDS crisis
since the beginning, in the 1980s. AVERT is a major stakeholder, and is working to stop
the spread of HIV/AIDS. AVERT is not an acronym, it goes in the phrase AVERTing
HIV/AIDS. They provide information on safer sex, as well as prevention.
Byrnes, B. (2014, March 25). Imperialism. Lecture presented at AP World History in
Leonardtown High School, Leonardtown.



This lecture was given during my freshman year AP World History class. The curriculum
is dictated by the CollegeBoard and is accepted as accurate. Byrnes delivered accurate,
trustworthy information in the form of a formal lecture in a classroom setting.
Calonico, S. (Director). (2015). When AIDS Was Funny [Motion picture on Online]. United
Mr. Calonico developed this short film in honor of world AIDS day. He compiled audios
from different interviews and press conferences from the Reagan administration
regarding the emergence of AIDS in the 1980s. The audios used are from the Library of
Congress, and are thus a reliable source. They are also a primary source because they
came directly from the conferences. While Calonico was unable to find any visual
footage, his audio compilation has brought to the light the attitude of the Reagan
administration regarding AIDS.
CDC / SMCHD. (2016, March 3). Public Health Core Functions and 10 Essential Services.
Lecture presented at SMCHD Interview for Internship in St. Mary's County Health
Department, Leonardtown.
This lecture and PowerPoint was presented to me at the time of my acceptance to intern
with the SMCHD. Ms. Prochnow used it to exhibit the services the health department
offers, and how public health plays a role in society. The presentation was created jointly
between the Center for Disease Control and local health departments to showcase their
work. This was really important for me to understand what I am helping with.
CDC. (2015, September 29). HIV in the United States: At A Glance. Retrieved January 19, 2016,



The Center for Disease Control obviously has credibility. They are at the American
forefront for fighting diseases such as HIV/AIDS. They had very useful statistics of
HIV/AIDS in the United States. I was able to use the statistics to support the growing
numbers of HIV/AIDS being found in the United States, and around the world.
Cropper, A. (2015, April 24). Eisenhower Administration. Lecture presented at AP United States
History in Leonardtown High School, Leonardtown.
This is a lecture from Adam Croppers AP United States History class. He spoke about
the Eisenhower administration, and this was when the health department was first started.
The SMCHD stems from this original health department. The source is reliable because it
was from an Advanced Placement, College Board backed course.
Essex, M., Mboup, S., Kanki, P., Marlink, R., Tlou, S. (2002). AIDS in Africa (2nd ed.). New
York, New York: Kluwer Academic/Plenum.
This book is an all-encompassing look into AIDS in Africa. It covers every aspect of the
epidemic from how it spreads to the most recent and innovative ways to stop it. While it
does not directly relate to the education aspect, this resource is an excellent place to go
for background information and any miscellaneous queries.
Fineberg, H., Mann, J., Sepulva, J. (1992). AIDS: Prevention through education: A world view.
New York, New York: Oxford University Press.
This book is especially useful to my project. Everything the authors are talking about in
this book goes along directly with my thoughts that education can be used to prevent
HIV/AIDS. They have several examples in which education has been successful in the
prevention of HIV/AIDS. Additionally, they have proposed several innovative ideas for
implementation around the world, such as a globalized HIV/AIDS education system.



Hall, P. (2016). Internship. SMCHD.

Working at the SMCHD, I had the opportunity to speak with and interview Ms. Patricia
Hall several times. She oversees the Infectious Disease Department, which houses
HIV/AIDS prevention, within the SMCHD and is a registered nurse, along with having
business qualifications. Instrumental in getting me set up within the SMCHD, she
assisted me in my project and answered any questions I had, not only pertaining to the
Infectious Disease Department but also to the SMCHD as a whole. She is a reliable
source for the SMCHD and my internship because she can give a first-hand account of
how the SMCHD functions and how they work to prevent HIV/AIDS in St. Marys
Harding, T. (2016, April 22). Nigeria. Lecture presented at AP Comparative Government and
Politics in Leonardtown High School, Leonardtown.
This lecture was presented as a component of Leonardtown High Schools AP
Comparative Government and Politics class. Ms. Harding presented the information as
dictated by CollegeBoard. The information contained about Nigeria was accurate and
contained recent statistics about the country.
HHS. (2015, August 28). Read the Law. Retrieved May 17, 2016, from
This is the Affordable Care Act, as implemented by the Obama administration. As a
government document found on a government website, it is the version of the Act that
had been passed, and thus holds credibility. It is a direct source from the government and
is not disputable.



Hiv/aids. (2010). In K. Reinert & R. Rajan (Eds.), The Princeton encyclopedia of the world
economy. Princeton, NJ: Princeton University Press.
Reinert and Rajan provide an excellent overview of HIV/AIDS as a whole. They have an
unbiased approach that covers every aspect of the epidemic from the beginning to the
economic consequences. They also write directly about the impact that education can
have on prevention, which is directly relevant to my project. This is an excellent source
because it is the most important facts and was a good starting point for the proposal. This
source also came from an academic database, so it is reliable and commonly used for
academia purposes.
Lewis, S. (2001). J'accuse. Current Sociology, 49(6), 1-3.
This academic journal contains several articles regarding HIV/AIDS. Lewis travelled to
an African village where he experienced first hand the impact that education can have on
the prevention of HIV/AIDS. Many of the children at the school he visited had lost
family members to the disease, and were learning preventative measures. Lewis is a
certified sociologist, and thus his expert opinion has credibility, in addition to his firsthand support. Current Sociology is found in databases from the St. Marys College of
Maryland library.
LoGuirato, B. (2013). The Stunning Way The White House And Reporters First Reacted To The
AIDS Crisis. Retrieved 5 August 2016, from
This article from Business Insider provides a transcript of the White House press
conferences with Larry Speakes. Speakes is featured in the short-film When AIDS Was



Funny, and the article provides the transcript that is used in the film. This is an easier way
to understand what Speakes was saying during the conferences because it is written out
instead only audio. The article is a reliable source because it is a direct transcript from
Speakes and the White House press conferences during the Reagan Administration.
Maryland Department of Health. (2008). St. Mary's County (1st ed., p. 2). St. Mary's County:
DHMH. Retrieved from
This Department of Health and Mental Hygiene report comes from the Maryland branch
of the Department of Health. As a government document it is reliable, and provides
statistics that are indisputable. The data comes from government research and is not
biased due to being apart of a funded study. It focuses on St. Marys County, which is
where I have chosen to focus my service.
Maticka - Tyndale, E. (2001). Twenty Years in the AIDS Pandemic: A Place for
Sociology. Current Sociology, 49(6), 13-19.
Maticka Tyndale had been following the AIDS pandemic since its inception, and was
viewing it through a sociological lense. Her ideas for prevention hinge on the sociology
of society and the actions that people will instinctively take. As a published sociologist,
she is well qualified to provide her opinion, and she backs herself up with history and
facts. Current Sociology is found in databases from the St. Marys College of Maryland
Mays, V. (1989). Primary prevention of AIDS: Psychological approaches. Newbury Park,
California: SAGE Publications.



Mays proposes more unorthodox ideas in this writing. The majority of the book is
looking into the idea that prevention must be taught before it can be implemented. It does
not matter if all the prevention in the world is available, but if the affected people do not
know how to use and take advantage of the prevention, then it serves no purpose. I feel
this is especially relevant to my project because it falls in a similar category to education.
McDaniels, A. (2015, July 4). HIV in young people rising in Maryland. Baltimore Sun. Retrieved
January 17, 2016, from
McDaniels provides the rising statistics of young adults in Maryland with HIV/AIDS.
These were the most currents statistics I was able to find. Her insight into the heart of
Maryland is one I was not able to find anywhere else. She writes locally from Baltimore,
and was the most local writer covering the epidemic that I was able to find.
Prochnow, T. (2016, March 3). Internship Discussion [Personal interview].
Ms. Prochnow provided a personal interview, in person, to me while I was discussing my
internship with her. She detailed my tasks as an intern and what I would be responsible.
She also further explained the roles the SMCHD holds and how they affect the
Richert, L. (2009). Reagan, Regulation, and the FDA: The US Food and Drug Administration's
Response to HIV/AIDS. Retrieved May 17, 2016, from
Richerts work is posted in a St. Marys College of Maryland database. The database is
designed for academic use and contains only academic-level sources. Richerts paper is
also an academic report, styled in APA format and published for the use of other



Rotello, G. (1997). Sexual ecology: AIDS and the destiny of gay men. New York, New York:
This writing features a chapter called holistic prevention. In this, the various ways of
preventing HIV/AIDS are laid out and the pros and cons given. I think this will be a
useful resource for my information and prevention night I have planned, because it goes
beyond solely education but encompasses the types of prevention people should be
educated about. It includes both mental / communicative prevention as well as physical
SMCHD. (2015). Saint Mary's County Health Department. Retrieved February 21, 2016, from
This is the main SMCHD website. Their homepage provides the most recent resources on
current diseases. Here, I was able to find information on what the SMCHD is currently
trying to tackle. This is a reliable source because it is a government website and is backed
by the local and national governments.
Some scientists ask, "does HIV cause AIDS?. (1995, February). Today's Science. Retrieved
This is from the Todays Science database, as a part of InfoBase learning. The source
provides information on both current and past scientific issues, and it provided by St.
Marys County Public Schools. It is a reliable source. At the end of the article, all of the
sources used to create the article can be found. It provides valuable information about
more than HIV/AIDS. Also, as an education-driven source, it would not post falsified or
untrue information.



UN. (2015). United Nations Millennium Development Goals. Retrieved January 19, 2016, from
The United Nation millennium goals are internationally recognized. Any issue that makes
this top eight is one to bring to the forefront of discussion. HIV/AIDS was on this list to
be eradicated.
UNAIDS. (2015). UNAIDS. Retrieved January 19, 2016, from
The UNAIDS organization is the primary international organization to combat
HIV/AIDS. On this website, there are reliable statistics that I found very helpful. They
provided statistics regionally, globally, and by each state. This showed trends, especially
between the global north and the global south.
World Bank. (2016). GDP (current US$) | Data. Retrieved 28 August 2016,
The World Bank provides data from different countries about their GDP. It takes
international data and provides information about countries given in U. S. dollars. It is a
reliable source because it is an international organization that is considered official by the
international community.
Weissman, D. (Director). (2011). We Were Here [Motion picture on Netflix]. United States:
This independently produced film follows the lives of five men living with HIV/AIDS
during its inception. Weissman found the true stories and personal documents of the
people he follows. The film is a compilation of primary sources, and has accuracy to the


time, making it a reliable source to display the unreliable nature of the Reagan
administration in handling the crisis.



Appendix A (AIDSVu, 2013)
People in Maryland living with HIV/AIDS as of 2012



Appendix B (Maryland Department of Health, 2008)
People in St. Marys County living with HIV/AIDS in 2008