Benchmark – Part A: Population Health Research and PICOT Statement
Grand Canyon University
Translational Research and Population Health Management
NUR-550
Introduction
Health disparity is the difference in the occurrence, mortality and prevalence of diseases and the associated adverse health issues that exist among groups of the population. These specific groups within the population maybe depicted by age, ethnicity or race, gender, income, education, disability, social class, sexual orientation, or geographic location (Center for Disease and Prevention, 2020). This paper will discuss the noticeable difference in the Human Immunodeficiency Virus (HIV) rates within minority groups namely Blacks/ African Americans and Latinos/ Hispanics. The demographics along with health determinants, nursing science, genomic and genetic, and epidemiology will also be explained and how these factors may affect populations health management. An overview of a possible solution will also be provided for resolving this issue in the minority population along with a PICOT statement.
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Ethnicity and race are linked to human ancestry. Race is defined as a group of people who have specific distinctive common physical traits, such as hair texture and skin color. Ethnicity means groups of people categorized according to a common language, race, tribe, religion, background or cultural origin (Blakemore, 2020). Ethnic and racial minorities is one of the fastest growing communities in the United States. Yet, figures on health status have revealed poorer health outcomes among racial and ethnic minorities regarding death and preventable diseases (National HIV Curriculum, 2021).
Population Demographic
Hispanics and Blacks noticeably out number all other racial and ethnic groups. In the year 2018 African American represented only 13% of the entire population but they accounted for 41% of people living with HIV. Latinos represent 15% of the population but they accounted for 23% of people living with HIV. Asians made up 6% of population and accounted for 1.5%. This disparity also exists in the new HIV infection rates. Subpopulations within these ethnic groups are more adversely affected. Men who have sex with men are affected the most. They represent 70% of all new HIV infections, even though they only make up 2% of the entire population. (National Curriculum of HIV, 2021).
Health Disparity
Health disparities are differences in injuries, violence, disease burden or experiences that prevent specific population from attaining maximum health and are experienced by populations that are socially disadvantaged. Despite medical advances in the treatment of HIV, minority groups continue to be one of public health biggest concerns. There are many variables that affect minority health. It is essential that practitioners of public health are aware of these disparities and how they affect these groups.
Nursing Science and Health determinants
Nursing actions and interventions focused on decreasing the inequalities that exist in health should be targeted at racial and ethnic minorities. These interventions should emphasize design and delivery to encourage and promote access and use of services and resources. Nursing science is crucial as it carries out research and apply the results to bridge the gap between clinical setting and specific populations (Grady, 2017). Numerous determinants do exist in understanding the distinctive and unique susceptibility to HIV in ethnic and racial minority populations. The determinants are trauma, poverty, and incarceration. These determinants are disproportionate in the minority groups especially Blacks and Latinos. For example, Latinos and Blacks are more likely to experiment with illegal substances or turn to sex work, both activities increase their vulnerability. The use of drugs and engaging in illegal activities can lead to increased incarceration rates, which damages the familial foundations and break up stable sexual partnerships increasing the vulnerability to HIV even more. These determinants are synergistic and reciprocal. Imprisonment may lead to unemployment and poverty. Poverty leads to increased risky behaviors and drug use. These behaviors increased the likelihood of them becoming infected. Research in social sciences has also correlated the experience of adverse health outcomes with stigma. Stigma and stress may contribute to increased numbers of depression, substance abuse, engaging in risky sexual behaviors which will increase the risk even more. For example, sex with multiple partners and condom less sex. (National Hiv Curriculum, 2021).
Epidemiolgy
Epidemiology continues to show that HIV infections rates are higher in minority groups. The estimated prevalence of HIV infection takes into consideration the entire population living with HIV, diagnosed and undiagnosed. In 2018, the Center for Disease Control and Prevention (CDC) reported that 1173,200 people 13 years and older were living with HIV of which 482,900 were Blacks and 274000 were Hispanics. Surveillance data also revealed that in 2018, 36,400 were newly infected of which 15,300 were black and 10,300 were Latinos. The projected overall lifetime risk of being infected with this virus in the U.S. is 0.94%-0.95%. This risk significantly varies by ethnic and racial groups and sex. Male has a lifetime risk of 1 in 68, however a black male is 1 in 22. Men who have sex with men from all ethnic/racial group are at a very high risk of becoming infected (1 in every 6). For black men it is (1 in 2). This shows the significant disparity that must be addressed to meet the goal of healthy people 2030. (National HIV Curriculum, 2021).
Genomic and genetics
The death rates among blacks are 6.5 times higher than whites and 3.6 higher than Latinos. Retrospective studies analysis of insurance records and hospitals revealed that blacks were 6 times more likely than whites to need hospitalization. Achieving suppression of plasma RNA is very crucial in the fight against HIV. Studies showed that after giving antiviral regimen to different population, blacks had 40% more virologic failure than whites and this was seen when replicated with multiple antiretroviral therapies medications. This is crucial when addressing disparity in fighting HIV in public health (National HIV Curriculum, 2021).
Potential Solutions and PICOT statement
A multidisciplinary approach will be needed to reduce the HIV disparity that exists in ethnic/racial groups. The structural and social drivers of HIV must be addressed and should be tailored to meet local and cultural needs of these populations. Community partnership will be needed, academic institutions, public and private players, media personnel and faith-based organizations can promote awareness, testing and prevention. For example, faith-based organization usually play a significant role with blacks. Faith based organizations can be used to promote Healthy People 2030 agenda-health for all with a specific focus on HIV. The HIV workforce should focus on the recruitment of minority practitioners as well as enhancing practitioner’s cultural competency. Racial concordance has shown to increase rates of testing for sexually transmitted disease among Black/American women and improve rates of adherence to medication regimen (National HIV Curriculum, 2021).
The PICOT statements. P- Ethnic and racial minority diagnosed with HIV. I- An analysis of the racial and ethnic health disparity that creates a barrier and increase the risk of minorities likelihood of getting infected. C-Promoting and enhancing equity to the access of quality healthcare to minorities living with HIV. O-Improved delivery and access to quality healthcare for minorities living with HIV; contributing to the 2030 healthy people goal whose mantra is building a healthier future for all. T 1-2 years.
Research carried out by academia should be translated to interventions that benefit minority communities. Results of these researches should also influence policies and programs that are specific to HIV and the minorities communities. Interventions that are replicable and sustainable should be implemented to stimulate innovation and research in meeting Healthy People 2030, health for all people. A foundational principle of healthy people 2030 is attaining well-being and health for everyone, which will require putting an end to health disparity, attaining health equity and accomplishing health literacy. For this to be achieved measurable national goal have to be set and guided by evidence-based programs and policies and provide factual, accessible and timely data that can guide selected interventions to address populations that are at high risks for poor health or have poor health outcomes (Office of Disease Prevention and Promotion, n.d.)
References
Blakemore, E., (2019). Race and ethnicity explained.
National Geographic.
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HIV in Racial and Ethnic Minority Populations – Core Concepts (uw.edu)
Centers for Didease Control and Prevention, (2020).
African American Blacks.
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African Americans | Health Disparities | NCHHSTP | CDC
Grady P.A. (2017). Investigating the determinants of health: The role of nursing science. Official Journal of the American Academy of Nursing.
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National HIV Curriculum, (2021).
Hiv in ethnic and racial minority populations.
https://
HIV in Racial and Ethnic Minority Populations – Core Concepts (uw.edu)
Office of Disease Prevention and Promotion, (n.d). Healthy people 2030 framework.
U.S.Department of Health and Human Services.
https://www.
Healthy People 2030 Framework – Healthy People 2030 | health.gov
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