Assigment .Apa seven . All instructions attached.

1

Health Promotion Proposal, Part 1

Robert Alonso

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice

Professor: Dr. Nora Hernandez

September 21, 2023

Sexually Transmitted Infections (STIs) in Miami, Florida

Sexually transmitted infections (STIs) remain a significant health concern in many parts of the world, including the United States. In cities like Miami, Florida, the prevalence of STIs such as gonorrhea, chlamydia, and syphilis are of particular concern, especially among vulnerable populations like men who have sex with men (MSM) and transgender women (TGW) (Abara et al., 2020). The proposed health promotion program will focus on enhancing the screening frequency for STIs, particularly for individuals on HIV pre-exposure prophylaxis (PrEP), aiming for early detection and timely treatment to reduce transmission.

Vulnerable Population: MSM and TGW

MSM and TGW form a unique vulnerable group in the context of STIs. Historically, this population has faced higher rates of STIs due to multiple risk factors. A combination of socio-cultural, economic, and health-related factors contribute to this vulnerability. Stigma, discrimination, and lack of access to healthcare services are some of the primary socio-cultural barriers this group faces. Behaviorally, many MSM and TGW report condomless anal sex, which enhances the risk of STI transmission. A study by Tang et al. (2020) found that 89.2% of participants with asymptomatic STIs reported condomless anal sex and had an average of 8.1 partners between quarterly visits. The socioeconomic disparities that MSM and TGW often face exacerbate their vulnerability to STIs (Tang et al., 2020). Many within this demographic lack stable housing and consistent employment, which can impede regular access to health care and STI prevention resources. Social isolation, driven by discrimination and marginalization, can lead to mental health challenges, including substance abuse, further increasing their susceptibility to STIs. The unique intersectionality of challenges faced by MSM and TGW necessitates a holistic approach in addressing their health concerns (Tang et al., 2020). Without understanding and addressing the broader socio-economic and cultural challenges this group faces, isolated medical interventions might fall short in significantly reducing STI rates among them. It underscores the importance of inclusive policies, community engagement, and multi-dimensional health programs tailored to the nuanced needs of MSM and TGW.

Review of Literature

Tang et al. (2020) focused on the optimal screening frequency of STIs for MSM and TGW on HIV PrEP. The study observed that quarterly STI screening among this group could prevent a significant number of partners from being exposed to asymptomatic STIs, thus reducing transmission. The strength of this study lies in its comprehensive cohort design and its focus on real-world STI clinics in Miami and other cities. One limitation might be its exclusive emphasis on participants on PrEP, which could exclude those not on PrEP. Abara et al. (2020) emphasized the importance of extragenital screening among MSM. Their research revealed that extragenital GC and CT were common among MSM, suggesting that without such screening, approximately 13% of MSM with urethral CT would have gone undetected and thus undertreated. This oversight could potentially result in the growth of antimicrobial resistance. The study's strength is its vast sample size and detailed analysis across multiple sites. However, a potential limitation is its concentration only on sexually transmitted disease clinics, which might not capture the entirety of the MSM community.

Geller et al. (2020) explored the intricate relationship between gender-based violence (GBV) and the risk of STI acquisition. Their multicenter, prospective study revealed that recent GBV experience increases the risk of subsequent self-reported STI diagnoses. The study identifies several significant risk factors for STI acquisition, including unstable housing, unemployment, transactional sex, and drug use. An interesting observation is the differential STI risk contributed by physical violence in HIV-seronegative women and lifetime GBV experience in HIV-seropositive women. These findings stress the importance of GBV prevention as it holds direct relevance to women's sexual health. Clement et al. (2021) assessed long-term outcomes of individuals initiating PrEP in the South, particularly concerning PrEP discontinuation and STI rates. The study, based in Durham, North Carolina, found that while PrEP programs reached a large number of uninsured, Black, and Latino MSM, the discontinuation rates were notably high. Furthermore, despite high PrEP discontinuation rates, the incidence of STIs remained elevated. This study underscores the need to delve deeper into the reasons behind PrEP discontinuation and find ways to keep patients in care, especially given the alarming rates of incident STIs and HIV diagnoses in the region.

Health Promotion/Disease Prevention Theoretical Model

The Health Belief Model (HBM) serves as an appropriate guiding framework for this proposal. The HBM posits that individuals' health-related actions depend on the perception of the severity of the potential illness, the person's susceptibility to that illness, the benefits of taking a preventive action, and the barriers to taking that action (Geller et al., 2020). In the context of STIs in Miami, utilizing the HBM can help understand the attitudes and beliefs of MSM and TGW about STIs. By understanding their perceived severity, susceptibility, benefits of screening, and barriers, tailored interventions can be developed to encourage frequent screenings and preventive behaviors. Recent data suggests that the rates of STIs are on the rise (Geller et al., 2020). According to the Centers for Disease Control and Prevention (CDC), nearly 2.5 million reported cases of chlamydia, gonorrhea, and syphilis were registered in the U.S. in 2019 (Geller et al., 2020). These rising numbers signify that STIs continue to be a significant public health concern. In Miami, Florida, the situation mirrors this national trend. The Miami-Dade County Health Department reported an increase in the number of STI cases, with chlamydia and gonorrhea seeing the highest surge (Geller et al., 2020). Such statistics naturally amplify the perceived severity and susceptibility of acquiring an STI among sexually active individuals, especially in vulnerable groups like MSM and TGW (Geller et al., 2020). The Health Belief Model postulates that when individuals perceive a higher risk and believe that the consequences of the illness are severe, they are more likely to take preventive measures.

However, there are several barriers to STI screening, even with the increasing prevalence. Stigma remains a profound deterrent, especially in communities where sexual health topics might be considered taboo or are not openly discussed (Clement et al., 2021). Concerns about confidentiality, judgment, and the repercussions of a positive diagnosis can deter individuals from getting tested. For MSM and TGW, who already face social stigmatization, these barriers can be even more pronounced. Conversely, the benefits of screening are undeniable: early detection, timely treatment, reduced risk of complications, and the peace of mind that comes with knowing one's status (Clement et al., 2021). Leveraging the Health Belief Model, if these benefits are emphasized and the barriers systematically addressed, it could lead to more individuals seeking regular screenings and adhering to preventive measures (Clement et al., 2021). In the case of Miami, community outreach, destigmatization campaigns, and ensuring access to confidential and non-judgmental health services can be instrumental in shifting health beliefs and behaviors towards proactive STI prevention.

In summary, the elevated rates of STIs among MSM and TGW in Miami highlight the need for more proactive health promotion efforts, focusing on more frequent screenings, early detection, and prompt treatment. By understanding and leveraging the intricacies of the Health Belief Model, interventions can be tailor-made to target this vulnerable population more effectively.

References

Abara, W. E., Llata, E. L., Schumacher, C., Carlos-Henderson, J., Peralta, A. M., Huspeni, D., ... & Kirkcaldy, R. D. (2020). Extragenital gonorrhea and chlamydia positivity and the potential for missed extragenital gonorrhea with concurrent urethral chlamydia among men who have sex with men attending sexually transmitted disease clinics—Sexually Transmitted Disease Surveillance Network, 2015–2019.  Sexually transmitted diseases,  47(6), 361.

Clement, M. E., Nicchitta, M., Sun, Y., Ellis, A., Chakraborty, H., McGee, K., ... & McKellar, M. (2021). PrEP Outcomes in an Urban Community in North Carolina: Discontinuation of Care and Sexually Transmitted Infections.  Sexually transmitted diseases,  48(3), 183.

Geller, R. J., Decker, M. R., Adedimeji, A. A., Weber, K. M., Kassaye, S., Taylor, T. N., ... & Golub, E. T. (2020). A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995–2018.  Journal of Women's Health,  29(10), 1256-1267.

Knittel, A., Rudolph, J., Shook-Sa, B., Edmonds, A., Ramirez, C., Cohen, M., ... & Adimora, A. (2019). The effects of incarceration on sexually transmitted infections in women with or at risk for human immunodeficiency virus in the United States.  American Journal of Obstetrics & Gynecology,  221(6), 693.

Tang, E. C., Vittinghoff, E., Philip, S. S., Doblecki-Lewis, S., Bacon, O., Chege, W., ... & Cohen, S. E. (2020). Quarterly screening optimizes detection of sexually transmitted infections when prescribing HIV preexposure prophylaxis.  Aids,  34(8), 1181-1186.

1

Health Promotion Proposal, Part 1

Robert Alonso

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice

Professor: Dr. Nora Hernandez

September 21, 2023

Sexually Transmitted Infections (STIs) in Miami, Florida

Sexually transmitted infections (STIs) remain a significant health concern in many parts of the world, including the United States. In cities like Miami, Florida, the prevalence of STIs such as gonorrhea, chlamydia, and syphilis are of particular concern, especially among vulnerable populations like men who have sex with men (MSM) and transgender women (TGW) (Abara et al., 2020). The proposed health promotion program will focus on enhancing the screening frequency for STIs, particularly for individuals on HIV pre-exposure prophylaxis (PrEP), aiming for early detection and timely treatment to reduce transmission.

Vulnerable Population: MSM and TGW

MSM and TGW form a unique vulnerable group in the context of STIs. Historically, this population has faced higher rates of STIs due to multiple risk factors. A combination of socio-cultural, economic, and health-related factors contribute to this vulnerability. Stigma, discrimination, and lack of access to healthcare services are some of the primary socio-cultural barriers this group faces. Behaviorally, many MSM and TGW report condomless anal sex, which enhances the risk of STI transmission. A study by Tang et al. (2020) found that 89.2% of participants with asymptomatic STIs reported condomless anal sex and had an average of 8.1 partners between quarterly visits. The socioeconomic disparities that MSM and TGW often face exacerbate their vulnerability to STIs (Tang et al., 2020). Many within this demographic lack stable housing and consistent employment, which can impede regular access to health care and STI prevention resources. Social isolation, driven by discrimination and marginalization, can lead to mental health challenges, including substance abuse, further increasing their susceptibility to STIs. The unique intersectionality of challenges faced by MSM and TGW necessitates a holistic approach in addressing their health concerns (Tang et al., 2020). Without understanding and addressing the broader socio-economic and cultural challenges this group faces, isolated medical interventions might fall short in significantly reducing STI rates among them. It underscores the importance of inclusive policies, community engagement, and multi-dimensional health programs tailored to the nuanced needs of MSM and TGW.

Review of Literature

Tang et al. (2020) focused on the optimal screening frequency of STIs for MSM and TGW on HIV PrEP. The study observed that quarterly STI screening among this group could prevent a significant number of partners from being exposed to asymptomatic STIs, thus reducing transmission. The strength of this study lies in its comprehensive cohort design and its focus on real-world STI clinics in Miami and other cities. One limitation might be its exclusive emphasis on participants on PrEP, which could exclude those not on PrEP. Abara et al. (2020) emphasized the importance of extragenital screening among MSM. Their research revealed that extragenital GC and CT were common among MSM, suggesting that without such screening, approximately 13% of MSM with urethral CT would have gone undetected and thus undertreated. This oversight could potentially result in the growth of antimicrobial resistance. The study's strength is its vast sample size and detailed analysis across multiple sites. However, a potential limitation is its concentration only on sexually transmitted disease clinics, which might not capture the entirety of the MSM community.

Geller et al. (2020) explored the intricate relationship between gender-based violence (GBV) and the risk of STI acquisition. Their multicenter, prospective study revealed that recent GBV experience increases the risk of subsequent self-reported STI diagnoses. The study identifies several significant risk factors for STI acquisition, including unstable housing, unemployment, transactional sex, and drug use. An interesting observation is the differential STI risk contributed by physical violence in HIV-seronegative women and lifetime GBV experience in HIV-seropositive women. These findings stress the importance of GBV prevention as it holds direct relevance to women's sexual health. Clement et al. (2021) assessed long-term outcomes of individuals initiating PrEP in the South, particularly concerning PrEP discontinuation and STI rates. The study, based in Durham, North Carolina, found that while PrEP programs reached a large number of uninsured, Black, and Latino MSM, the discontinuation rates were notably high. Furthermore, despite high PrEP discontinuation rates, the incidence of STIs remained elevated. This study underscores the need to delve deeper into the reasons behind PrEP discontinuation and find ways to keep patients in care, especially given the alarming rates of incident STIs and HIV diagnoses in the region.

Health Promotion/Disease Prevention Theoretical Model

The Health Belief Model (HBM) serves as an appropriate guiding framework for this proposal. The HBM posits that individuals' health-related actions depend on the perception of the severity of the potential illness, the person's susceptibility to that illness, the benefits of taking a preventive action, and the barriers to taking that action (Geller et al., 2020). In the context of STIs in Miami, utilizing the HBM can help understand the attitudes and beliefs of MSM and TGW about STIs. By understanding their perceived severity, susceptibility, benefits of screening, and barriers, tailored interventions can be developed to encourage frequent screenings and preventive behaviors. Recent data suggests that the rates of STIs are on the rise (Geller et al., 2020). According to the Centers for Disease Control and Prevention (CDC), nearly 2.5 million reported cases of chlamydia, gonorrhea, and syphilis were registered in the U.S. in 2019 (Geller et al., 2020). These rising numbers signify that STIs continue to be a significant public health concern. In Miami, Florida, the situation mirrors this national trend. The Miami-Dade County Health Department reported an increase in the number of STI cases, with chlamydia and gonorrhea seeing the highest surge (Geller et al., 2020). Such statistics naturally amplify the perceived severity and susceptibility of acquiring an STI among sexually active individuals, especially in vulnerable groups like MSM and TGW (Geller et al., 2020). The Health Belief Model postulates that when individuals perceive a higher risk and believe that the consequences of the illness are severe, they are more likely to take preventive measures.

However, there are several barriers to STI screening, even with the increasing prevalence. Stigma remains a profound deterrent, especially in communities where sexual health topics might be considered taboo or are not openly discussed (Clement et al., 2021). Concerns about confidentiality, judgment, and the repercussions of a positive diagnosis can deter individuals from getting tested. For MSM and TGW, who already face social stigmatization, these barriers can be even more pronounced. Conversely, the benefits of screening are undeniable: early detection, timely treatment, reduced risk of complications, and the peace of mind that comes with knowing one's status (Clement et al., 2021). Leveraging the Health Belief Model, if these benefits are emphasized and the barriers systematically addressed, it could lead to more individuals seeking regular screenings and adhering to preventive measures (Clement et al., 2021). In the case of Miami, community outreach, destigmatization campaigns, and ensuring access to confidential and non-judgmental health services can be instrumental in shifting health beliefs and behaviors towards proactive STI prevention.

In summary, the elevated rates of STIs among MSM and TGW in Miami highlight the need for more proactive health promotion efforts, focusing on more frequent screenings, early detection, and prompt treatment. By understanding and leveraging the intricacies of the Health Belief Model, interventions can be tailor-made to target this vulnerable population more effectively.

References

Abara, W. E., Llata, E. L., Schumacher, C., Carlos-Henderson, J., Peralta, A. M., Huspeni, D., ... & Kirkcaldy, R. D. (2020). Extragenital gonorrhea and chlamydia positivity and the potential for missed extragenital gonorrhea with concurrent urethral chlamydia among men who have sex with men attending sexually transmitted disease clinics—Sexually Transmitted Disease Surveillance Network, 2015–2019.  Sexually transmitted diseases,  47(6), 361.

Clement, M. E., Nicchitta, M., Sun, Y., Ellis, A., Chakraborty, H., McGee, K., ... & McKellar, M. (2021). PrEP Outcomes in an Urban Community in North Carolina: Discontinuation of Care and Sexually Transmitted Infections.  Sexually transmitted diseases,  48(3), 183.

Geller, R. J., Decker, M. R., Adedimeji, A. A., Weber, K. M., Kassaye, S., Taylor, T. N., ... & Golub, E. T. (2020). A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995–2018.  Journal of Women's Health,  29(10), 1256-1267.

Knittel, A., Rudolph, J., Shook-Sa, B., Edmonds, A., Ramirez, C., Cohen, M., ... & Adimora, A. (2019). The effects of incarceration on sexually transmitted infections in women with or at risk for human immunodeficiency virus in the United States.  American Journal of Obstetrics & Gynecology,  221(6), 693.

Tang, E. C., Vittinghoff, E., Philip, S. S., Doblecki-Lewis, S., Bacon, O., Chege, W., ... & Cohen, S. E. (2020). Quarterly screening optimizes detection of sexually transmitted infections when prescribing HIV preexposure prophylaxis.  Aids,  34(8), 1181-1186.