HIV-AIDS Prevention & Advocacy Through Legislation

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Table of Contents

Problem
The idea for Addressing Solution
Researching the Issue
Stakeholder Support
Stakeholder Opposition
Financial Incentives/Costs
Legislature: Information Needed and Process for Proposal
Christian Principles and Nursing Advocacy
References

Problem

The epidemic of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has been holding a status of an epidemic since its early cases’ discovery in the 1980s. Currently, the state of Florida is a leader in the new HIV cases nationwide, constituting 4,584 new diagnoses in 2019 (Centers for Disease Control and Prevention [CDC], 2021b). Although the virus does not discriminate the population and may affect anyone, the most vulnerable populations concern sexual and ethnic minorities, as most HIV cases are found in the Black community (57,8%) and men having sexual intercourse with men (MSM, 75%) (Florida Department of Health, 2019). Given that the number of new infections continues to decrease, the progress is insignificant compared to other states and their preventive practices. Despite the existing programs to promote HIV/AIDS prevention among the population and criminalization of the failure to disclose HIV status prior to sexual intercourse, the Florida state legislature does not obtain any mandatory outreach and education programs for the population.

Additionally, the focus has not been placed on the mandatory state outreach programs for the minority groups in question, as the access to HIV testing is dependent directly on the regularity of the patients’ medical check-ups. In case the issue continues, the new case rates will increase, deteriorating the magnitude of the pandemic. On the other hand, access to preventive initiatives such as pre-exposure prophylaxis (PrEP) in high-risk groups is necessary to slow down the rate of virus dissemination among ethnic and sexual minorities.

The idea for Addressing Solution

The modern definition of health care is comprised of both quality medical assistance and communication with the population on the matter of health awareness and prevention. For this reason, as far as HIV/AIDS prevention is concerned, it is necessary to present a public initiative that would encourage nurses to share knowledge about HIV prevention and sex education among different communities. The existing Florida legislations describe the benefits of promoting HIV/AIDS prevention and testing, yet the nurses’ participation in educational endeavors is recommended with no further motivation (Florida Department of Health, 2021). The existing initiative called “Know your HIV status” is beneficial for people willing to learn about HIV prevention and treatment. However, while nurses address their patients to the network, a number of high-risk patients ignore the educational resource. For this reason, the newly introduced legislation should present a financial incentive for the nurses to eliminate the mediatorship and educate the community directly. More precisely, the legislation should include:

The provision to financially motivate community nurses to create educational curriculum for the populations of high risk of HIV infections.
The increase in financial resources allocated for the preventive measures, including mass testing, social advertisement, and educational intervention programs for at-risk communities, namely, sexual and ethnic minorities.

The aspect of financial incentive is critical due to the fact that financial incentives will eventually save the state’s money allocated for antiretroviral therapy (ART) for the population. The nationwide issue of nursing shortage will also be addressed.

Researching the Issue

Evidence 1

SB 818: Illinois Keeping Youth Safe and Healthy Act (2021): the initiative to reorganize the sex education curricula to include the education on HIV prevention and the definition and function of PrEP and regular HIV testing procedures. The existing legislation presents evidence on the benefits of allocating public funding to education.

Evidence 2

The study by Sarkar et al. (2019) demonstrates that besides being generally more cost-efficient than ART, PrEP promotion tends to save costs when targeted as high-risk populations: “PrEP was most cost-effective when using a prioritization strategy aimed at young individuals who are most at-risk, including having more than four partners and reporting low condom use” (p. 21).

Evidence 3

The research by Eakle et al. (2018) demonstrates that the abandonment of education and prevention-as-treatment interventions such as PrEP will result in the steadily rising magnitude of the epidemic: “Research has shown that ART will not reduce the epidemic enough to move towards elimination, or even control” (p. 8).

Stakeholder Support

Stakeholder(s) Supporting 1

Community nurses and community health establishments will be in favor of creating comprehensive prevention programs once they are financially incentivized to reduce the high-risk groups’ exposure to HIV.

Stakeholder(s) Supporting 2

Local community residents are likely to support the initiative due to its potential to secure more safety in terms of HIV dissemination and infection risk. Moreover, they will have no need to search for resources on their own, as they will be presented with a ready-made outreach initiative.

Stakeholder(s) Supporting 3

Federal health department representatives are likely to support the legislation due to its cost-efficiency in the long term, as millions of dollars are allocated annually on the ART assistance programs for the population.

Stakeholder Opposition

Stakeholder(s) Opposed 1

Republican legislators and state health department: Considering both the controversial views on sexual and ethnic minorities by the GOP, currently prevailing in the state of Florida, and the request to allocate more money on preventive rather than secondary medical assistance, the state legislature can be reluctant to embrace the initiative.

The argument used in defense will demonstrate the likelihood of decreasing the infection rates in the long run, as well as the projected cost savings on the initiative.

Stakeholder(s) Opposed 2

Faith-based organizations: While being some of the vital agents in public health promotion and well-being, faith-based organizations’ stance on explicit sex education, especially in the context of MSM, is sometimes questionable, as they tend to promote monogamous relationships rather than initiate the talk on safe sexual intercourse. For this reason, it will be necessary to dwell on the Christian perspective of service and assistance.

Financial Incentives/Costs

Initially, the costs for the organization of the preventive agenda and financial support for community nurses will be added to the annual spending on HIV prevention in the state. These costs can be added through external investors and partnerships with the NGOs. In the long-term perspective, the initial investment will be returned with decreased spending on ART public procurement, as the monthly cost of HIV treatment varies between $2,000 to $4,000 (Shaw, 2020). When it comes to HIV treatment, the government allocates finance on covering ART for people eligible for such programs as Medicaid, Medicare, Ryan White HIV/AIDS program, Children’s Health Insurance Program, and others. The reduction of ART spending in the long term will pay off and cover the costs for additional nurse pay and preventive interventions.

Currently, the total lifetime treatment cost for the treatment of new HIV cases in Florida constitutes more than $2 billion (CDC, 2021a). Research indicates that with the introduction of PrEP and education, the government may reduce the case incidence by at least 3% in a decade (Cambiano, 2018). Costing nearly $346 thousand a case, the state government can save nearly $60 million of HIV costs ten years after the initial introduction.

Legislature: Information Needed and Process for Proposal

The steps of presentation the issue to the legislator

Referral of the draft proposal to the county legislator;
Drafting the bill to the committee;
Hearing and mark up;

The process of introduction the idea as a bill to Congress

Once the bill is introduced to Congress, a written report to the House of Senate will be prepared, summarizing the call to action and primary legislation agents. After expertise, the bill will be passed to Congress with the intention to collect votes in favor or against. The voting will take place for every aspect of the bill, in case separate proposals will be ratified as amendments to the existing bills.

Christian Principles and Nursing Advocacy

One of the pillars of the Christian worldview on health care is being of service to the community, especially when it comes to the vulnerable populations that cannot secure access to education and support on their own. For this reason, the support for legislative advocacy should be perceived as means to help the community without discriminating on the basis of the financial and socio-cultural status of an individual. The legislation in question presents an invaluable opportunity for assisting a vulnerable community in order to support the health and well-being of the whole population, as the ethical and Christian principle of beneficence focuses on maximizing the good for the population.

The issue of HIV and sexually transmitted infections, in general, is complex in the context of church and Christian principles. However, over the past decades, the church has embraced education and promotion of contraception as means of HIV/AIDS prevention. Hence, the introduction of the legislation to dwell on the prevention and awareness of the community’s health is compatible with the fundamental Christian principles.

References

Cambiano, V., Miners, A., Dunn, D., McCormack, S., Ong, K. J., Gill, O. N., Nardone, A., Desai, M., Field, N., Hart, G., Delpech, V., Cairns, G., Rodger, A., & Phillips, A. N. (2018). Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: A modelling study and health economic evaluation. The Lancet Infectious Diseases, 18(1), 85-94. Web.

Centers for Disease Control and Prevention. (2021a). HIV cost-effectiveness. Web.

Centers for Disease Control and Prevention. (2021b). HIV: Statistics overview. Web.

Eakle, R., Venter, F., & Rees, H. (2018). Pre-exposure prophylaxis (PrEP) in an era of stalled HIV prevention: Can it change the game? Retrovirology, 15(1), 1-10. Web.

Florida Department of Health. (2019). Men with an HIV diagnosis in Florida, 2019 [PDF document]. Web.

Florida Department of Health. (2021). HIV/AIDS. Web.

Florida Senate. (2022). Senator Gayle Harrell. Web.

Keeping Youth Safe and Healthy Act. (2021). Web.

Sarkar, S., Corso, P., Ebrahim-Zadeh, S., Kim, P., Charania, S., & Wall, K. (2019). Cost-effectiveness of HIV prevention interventions in sub-Saharan Africa: A systematic review. EClinicalMedicine, 10, 10-31. Web.

Shaw, M. L. (2020). What is the true cost of the high price of ART? Web.

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