HEALTH POLICY FOR HIV PREVALENCE 1

Health Policy for HIV Prevalence

Natalie C. Sorensen

College of Nursing, University of South Florida

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Title of the Paper

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The purpose of this paper is to propose a health policy to address HIV prevalence among

Black MSM in Bibb County, GA. The policy will implement a program that provides free HIV

self-tests to Bibb County residents. This program’s aim is to increase testing frequency in order to

reduce HIV prevalence.

Identification of a Population-Specific Priority Health Concern

HIV prevalence is a population-specific priority health concern in Bibb County, Georgia as

it affects Black men who have sex with men, or MSM, more heavily than other populations in

Bibb County. Statistics show that 76% of people with HIV in non-EMA counties of Georgia such

as Bibb (EMA counties are counties surrounding Atlanta) are male, and 67% are Black (GDPH,

2021). Most of these men are MSM, as 84% of Black males diagnosed with HIV in the state of

Georgia are MSM (GDPH, 2021). Healthy People 2030 has an objective to reduce new HIV

diagnoses, which will reduce overall HIV prevalence ().

Population Diagnosis

Black MSM in Bibb County are at risk for HIV diagnosis related to HIV stigma and MSM

stigma.

Impact of Community Health Models

Interventions that address HIV prevalence can be used when formulating health policy to

improve HIV prevalence. However, it is also important to consider the factors that impact the

health of the community who is affected by the HIV prevalence. This is because policies that

address such factors will be more effective, as they take into consideration what may be

exacerbating a health issue.

Interventions that can be used to formulate health policy for reducing HIV prevalence in

Bibb County are the following: the primary prevention strategy of free condom distribution, the

secondary prevention strategy of promoting free HIV self-testing, and the tertiary prevention

strategy of encouraging partners of HIV positive individuals to start pre-exposure prophylaxis

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(PrEP) therapy promptly. In order to consider the factors impacting the health of the Black MSM

community of Bibb County, one can refer to a community health model known as the Social

Determinants of Health (SDOH) Model (ODPHP, 2020). This model identifies five key areas in

which social determinants of health can be grouped. Social determinants of health are conditions

in which people live that impact their health outcomes, and the two that affect HIV prevalence are

poverty and discrimination. Poverty contributes to HIV prevalence as people neglect purchasing

STI protection products in order to purchase necessities such as food (Garcia et al., 2016).

Discrimination contributes to HIV prevalence as populations at higher risk for HIV such as MSM

may avoid healthcare due to negative past experiences with stigma (Mbeda et al., 2020). As a

result, the proposed policy discussed below attempts to address both of these determinants.

Secondary Level of Prevention

The proposed policy below is based on the secondary prevention strategy of providing free

HIV self-testing. Self-testing has been found to increase testing frequency among MSM, which

can lead to reduced HIV prevalence by preventing accidental transmissions (Katz et al., 2018). As

a result, this intervention is a strong fit for reducing HIV prevalence among Black MSM in Bibb

County. In order to successfully implement this intervention in Bibb County, stakeholders such as

the Macon-Bibb County Health Department and state legislators need to be involved. The public

health nurse serves a role in this implementation as well by providing education to recipients of the

HIV self-tests, which includes all Bibb County residents, although the goal of the intervention is to

reduce HIV prevalence among Black MSM in Bibb County (Chiou et al., 2019).

Development of Health Policy

Health policy has a substantial impact on health care as it can assist in disease prevention

as well as health promotion (). This is because health policy influences the behavior of a

community by either encouraging certain behaviors or discouraging certain behaviors. The way
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that health policy encourages or discourages certain behaviors is by setting goals and driving the

funding of those goals.

Policy Proposal

Healthy People 2030 has established a goal of reducing sexually transmitted infections

(STI’s) and STI complications as well as improving quality STI care access (). An objective that

Healthy People 2030 has identified to meet this goal is to increase people’s knowledge of their

HIV status (). A proposed policy that addresses this objective is to reduce HIV prevalence in Black

MSM in Bibb County through the provision of free HIV self-testing kits. This policy addresses the

objective regarding status awareness as providing free self-testing will likely increase the

frequency of testing, which means more status awareness. This policy also addresses the issue of

HIV prevalence in Black MSM in Bibb County as more status awareness can lead to less

accidental transmission, leading to lower HIV prevalence. The impact of self-testing on testing

frequency can be seen in a randomized controlled trial conducted with a sample of MSM in

Seattle, as the group with access to self-tests reported having tested for HIV significantly more

than the group who tested as usual (p<0.0001) (Katz et al., 2018).

Policy and Program Implementation

The program that seems most appropriate for reducing HIV prevalence among Black MSM

in Bibb County is a program in which the Macon-Bibb County Health Department provides free

HIV self-tests to Bibb County residents. In order to promote the program, it is important to post

flyers about the program in gay bars and clubs as well as community centers. In order to help the

program take off, state legislators need to be approached to receive funding to compensate the

Macon-Bibb County Health Department for the provision of these tests. Healthcare professionals

in the county such as nurses, physicians, etc. can serve as stakeholders in addition to the state

legislators and county health department as they can help lobby for the program. Funding by the

state would modify the tax base. Another potential aid for funding could include hospitals willing
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to donate funds, philanthropic groups that focus on the health of the community, and gay pride

organizations. In order to engage these potential funding aids, it is possible to have the healthcare

professionals who are supporting this program approach these groups. Potential opposition to this

program includes religious groups, community members opposed to increased taxes, etc. The

opposition will likely lobby against the program by appealing to their government representatives,

which can threaten the program as representatives will not support an effort that can jeopardize

their positions. In order to address opposition, appealing to the idea of saving lives can potentially

help the opposition look past their bias against this program.

Conclusion

In summary, a program that provides free HIV self-testing to Bibb County residents

should improve testing frequency, and consequently, reduce HIV prevalence among Black MSM.

Reducing HIV prevalence among Black MSM in Bibb County is crucial as most of the HIV

cases in Bibb County as Black MSM.

Personal Relevance

This course has opened my eyes to health disparities and how they can be addressed. This

paper series has taught me how complex it is to change health outcomes and how many factors

impact health outcomes. This will influence my career as a nurse as I will be more aware of

potential disparities among my patients in the hospital and try to provide all the resources I can

to them to combat these.

References

Chiou, P. Y., Chien, C. Y., Lee, A., Mark, H., & Ko, N. Y. (2019). Experiential learning of HIV

self-test among student nurses: A qualitative study. Nurse education today, 79, 111–116.

https://doi.org/10.1016/j.nedt.2018.11.012
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US Department of Health and Human Services. (2022). Health Policy. Healthy People 2030.

https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-policy

US Department of Health and Human Services. (2022). Increase Knowledge of HIV Status.

Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-

objectives/sexually-transmitted-infections/increase-knowledge-hiv-status-hiv-02