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<!-- EDIT BELOW THIS LINE --Running Head: Vulnerable population

Name: Institution: Date:

Definition and Identification Human immunodeficiency virus (HIV) refers to a virus that attacks one’s immune system which represents the natural defense system of a human body. When this defense system is weakened, the body becomes susceptible to various diseases and infections. The virus that attacks the immune system as well as the infection that affects the body as a result of weak immune system is called HIV. The main parts that are attacked by this virus are the white blood cells which represent very important parts of the immune system. R the years, HIV has killed millions of people around the world. African Americans living in the United States represent one of the groups that are adversely affected by HIV. In 2014 alone, 5,128 African American women were diagnosed with HIV compared to 1,483 white women and 1,350 Latino/Hispanic women (CDC, 2016). This study is going to investigate the problem of HIV among this vulnerable population. The study will also investigate the risk factors of HIV among this population. Finally, the study is going to discuss the nursing implications. Problems, Susceptibility, Exposures and Frequency An earlier report by Global-Campaign in 2006 indicated that of the total population of the United States, African Americans only account for 13 percent. However, African Americans account for more than half of all new HIV cases in the U.S. especially the women, making them a vulnerable community. (Ragsdale-Hearns, 2012). The interventions and public health initiatives to address the problem of HIV has to be long-term rather that short-term. Therefore, community health nurses have to look 10 to 30 years ahead for ways to prevent the spread of HIV among this group. An intervention will help bridge the gap between individuals who are HIV negative and those who are HIV positive. Yellin (2006) indicated that 40 percent of new HIV cases which are diagnosed in women in the US are African American. He also found out that women of the African-American origin are 23 times more likely to be found with HIV compared to white women. This shows that African American women are the most affected group by HIV among all racial groups in the USA making their exposure to HIV and AIDS high and more frequent. Prejudices The high rate of incarceration and violent deaths has led to high loss of African American men which has then resulted in sex ratio imbalance. This situation has rendered African American women less powerful and in control to negotiate safer relationships. Women have significantly altered their self-protective behaviors in a way that are driven by fear of losing their partners. African American women also experience stigmatization and internalized oppression as a result of racism, sexism, and class exploitation. These forms of stigmatization make these women inhibit disclosure of their HIV status. These forms of discrimination and stigmatization within the African American population may explain why African American women continue to be one of the groups hard hit by HIV pandemic with diagnosis rates rising as twice as much compared to the white community. Also, the social status and geographical location of African American women affect their risk for HIV. Previously, researchers have linked inequalities of class, race/ethnicity, sexuality and gender with the distribution rate of HIV infection. One of the most important factors that CHNs should consider when drafting their intervention strategies is African American culture. Forms of resiliency This population has been very resilient due to various factors and reasons. African American adolescents have significantly benefited from culturally-appropriate risk reduction interventions. It is important for community health nurses to engage these adolescents in education and counseling sessions which are both gender and culturally specific, and should incorporate modules on HIV transmission, healthy relationships, condom usage, and effective communication skills. The intervention strategies that produce a greater reduction in high-risk behaviors are strategies that appeal to the cultural sensitivity of such at-risk populations. It is necessary to change both the behavior of these individuals as well as their social networks and communities if nurse intervention strategies are to bear fruits. The interventions and public health initiatives to address the problem of HIV has to be long-term rather that short-term. Therefore, community health nurses have to look 10 to 30 years ahead for ways to prevent the spread of HIV among this group. Intervention will help bridge the gap between individuals who HIV negative, HIV positive, and those infected with HIV. Community Programs This section is going to discuss two of the most effective community programs available for HIV/AIDs population among the African American women. Over the years, these programs have helped numerous African American women with HIV/AIDs in the United States. SisterLove Inc. SisterLove Inc. Is one of the community programs based in Atlanta focused on helping the African American women affected by HV/AIDs. The group also addresses HIV-related disparities affecting African American women. CDC has recognized SisterLove as one of the most effective programs in reducing HIV-related disparities among the African American women in the United States (CDC, 2014). The program also addresses the shared cultural aspects of African American women’s experiences that usually affects their vulnerability to HIV infection. Peers Reaching Out and Modeling Intervention Strategy (PROMISE) PROMISE represents one of the community-led programs that have achieved great success in reducing HIV risk among the African American population. This program recruits people who have been diagnosed with HIV to act as role models who disseminate materials and information to their peers who are also HIV-positive to help them move towards safer practices. Nursing Implications Primary Both the young and older African American women are contracting HIV infections at very high rates. However, little attention is being given towards their prevention needs. Teaching and counseling the two sub-groups of women is imperative to reduce the incidences and the transmission of HIV among the two sub-groups. It is the role of community health nurses engaged with African American women with HIV to employ strategies that will prevent the HIV negative African American women from getting infected with the disease. A significantly large number of HIV negative women are living and interacting with the HIV positive women. The highest at risk age-group is the adolescent girls. Educational and counseling initiatives must be increased among this age-group to increase their understanding of the importance of abstinence or safe sexual practices. Sexual practices are not the only way that these girls are contracting the disease – this group is contracting the disease through other means, including injections for those who are into drug abuse which is also considered to be one of the greatest risk-factors in this group. Lack of enough attention on risk factors such as gender roles, gender inequalities, promiscuity among the African American women, and substance abuse poses major challenges that prevent African American women from participating in HIV community programs. A significant number of African American women who are into promiscuity and prostitution were abused during their childhood stages. In turn, these women turn to drugs and alcohol. Drugs and alcohol impair the ability of these women to function well in all areas of their lives, including engaging in behaviors that are risky thus exposing themselves to HIV/AIDS. Nurses should also extend their prevention initiatives to African American women who are over 49 years old because HIV infection rate among the women of this age group has been found to be high. Women who are in this age group fail to see themselves as at risk for HIV; therefore, they do not take necessary precautions to prevent its transmission. Women in this age-group avoid using condoms because they no longer fear getting pregnant; therefore, nurses should advise these women always to use condoms to prevent themselves from contracting HIV. Secondary Secondary prevention Community health nurses should encourage African American women to go for HIV tests to know their HIV status earlier enough for early interventions. Data and information on those who are infected will help nurses identify the extent of the problem and formulate appropriate intervention strategies earlier enough. There are two ways in which nurses can use to help African American women who have just been diagnosed with HIV/AIDS. First, nurses should use strategies of helping these women accept their status, counsel them, and encourage them. Over the past, spirituality has historically served important role within this community’s culture, including survival, coping, improvement of health outcomes, and maintenance of overall well-being (Dalmida, Holstad, Dilorio & Laderman, 2012). Women who are HIV-positive women view spirituality as one of the most important resources for helping them cope with the stress factors and problems associated with their status (Bosworth, 2006). Therefore, nursing intervention among women with HIV should incorporate the spirituality aspect. Spirituality helps improve the health-related quality of life and immune function among these women. After finding out that they are HIV-positive, people go through a challenging time trying to cope with their changed health status and the reality of their situation. Tertiary prevention For those women whose HIV status is highly advanced, it is the role of the nurse to explain the action of each antiretroviral drug and instill knowledge for individual’s self-administration. This includes strong precautions about rigidly adhering to the dosage, time, and frequency of drug administration to avoid development of drug resistance. Describing the side effects of drug therapy to these women is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing nurse. The nurse should arrange appointments for laboratory tests for monitoring the effects of drug therapy among this group. Individuals who are HIV positive need to eat a good diet. Most of African Americans who are HIV positive live in regions which have a high poverty rate. Therefore, it is necessary that community health nurses who are engaged in intervention strategies to incorporate the economic factor, that is, how they can contribute to increasing the economic status of African American women living with HIV/AIDS. Another perspective of helping those whose HIV infections have reached advanced levels is to help them redefine themselves and find meaning in life (Smith & Liehr, 2013). Greater life purpose is associated with higher resilience, communication efficiency, and optimism. Nurses can, therefore, help these women understand and value their life thereby improving their resilience. There is a close relationship between spirituality and well-being in HIV-positive African American women. Therefore, nurses can approach this problem through logotherapy where they can help these women see life in terms of solutions rather than seeing it in terms of problems; focusing on goals rather than obstacles; having a holistic view rather than reductionistic view; and emphasizing on discovering rather than uncovering. Logotherapy can help African American women whose HIV status is highly advanced separate themselves from their symptoms and arouse the dynamic power of human spirit. Helping them find meaning will facilitate awareness of their subconscious commitments and beliefs and enable them discover their values. Frankl (1969) described three logotherapeutic approaches, including dereflection, paradoxical intention, and Socratic dialogue. This paper suggests that nurses should approach this problem through paradoxical intention and Socratic dialogue. Through paradoxical intention approach, the nurses will help the women to confront their anxieties and fears. It will strengthen their capacity to self-distance. Another approach is the Socratic dialogue which includes the conversation of questions and answers, probing deeply into existential issues such as one’s values. Such rhetorical debates trigger a change in attitude, behavior or both. It helps a person to discover himself/herself. The nurse poses questions so that the affected persons can become aware of their unconscious decisions, their un-admitted self-knowledge, and their repressed hopes. Through this approach, the nurse and the infected person will explore the person’s past experiences as well as her fears for the future. Both the paradoxical intention and Socratic dialogue provide tools to tap into inner resources to emerge as a stronger and more joyous self. Conclusion In conclusion, it is clear that women are among the vulnerable population in the USA. More so when the women are from the African –American origins and are HIV positive, they encounter enormous challenge in their daily lives. Their HIV statuses are made worse by a number of factors, including poverty and limited resources, limited access to health care and limited HIV prevention education. Appropriate responsive measure by the nursing practitioners taking care of the HIV positive African American using the above discussed ways will help them live a better life and a comfortable one. Failure to provide this intervention will only worsen the situation. The intervention should be long-term and cover all aspects of nursing intervention, including the primary, secondary, and tertiary prevention.

References Bosworth H. (2006). The importance of spirituality/religion and health-related quality of life among individuals with HIV/AIDS. Journal of General Internal Medicine, 21(5), S3–S4. Centers for Disease Control and Prevention. (2011a). Fact sheet: HIV among African Americans. Retrieved from 	http://www.cdc.gov /hiv/topics/aa/PDF/aa.pdf Dalmida, S. G., Holstad, M. M., DiIorio, C., & Laderman, G. (2012). The Meaning and Use of Spirituality Among African American Women Living With HIV/AIDS. Western Journal of Nursing Research, 34(6), 736–765. http://doi.org/10.1177/0193945912443740 Frankl, V. (1969). The Will to Meaning. New York: New American Library Ragsdale–Hearns, B. (2012). A Study of the Lack of HIV/AIDS Awareness Among African American Women: A Leadership Perspective. Bloomington: Trafford Publishing Smith, M. & Liehr, P. (2013). Middle Range Theory for Nursing: Third Edition. New York: Springer Publishing Company Yellin, T. (2006). ‘Out of Control: AIDS in Black America’ A Special Edition of ‘Primetime’ [Review of the documentary “Out of Control: AIDS in Black America]. ABC News Internet Ventures. Retrieved from http://abcnews.go.com/Primetime/Story?id=2346857&pa ~Sandra~

Running Head: Vulnerable population

Name: Institution: Date:

Definition and Identification Human immunodeficiency virus (HIV) refers to a virus that attacks one’s immune system which represents the natural defense system of a human body. When this defense system is weakened, the body becomes susceptible to various diseases and infections. The virus that attacks the immune system as well as the infection that affects the body as a result of weak immune system is called HIV. The main parts that are attacked by this virus are the white blood cells which represent very important parts of the immune system. R the years, HIV has killed millions of people around the world. African Americans living in the United States represent one of the groups that are adversely affected by HIV. In 2014 alone, 5,128 African American women were diagnosed with HIV compared to 1,483 white women and 1,350 Latino/Hispanic women (CDC, 2016). This study is going to investigate the problem of HIV among this vulnerable population. The study will also investigate the risk factors of HIV among this population. Finally, the study is going to discuss the nursing implications. Problems, Susceptibility, Exposures and Frequency An earlier report by Global-Campaign in 2006 indicated that of the total population of the United States, African Americans only account for 13 percent. However, African Americans account for more than half of all new HIV cases in the U.S. especially the women, making them a vulnerable community. (Ragsdale-Hearns, 2012). The interventions and public health initiatives to address the problem of HIV has to be long-term rather that short-term. Therefore, community health nurses have to look 10 to 30 years ahead for ways to prevent the spread of HIV among this group. An intervention will help bridge the gap between individuals who are HIV negative and those who are HIV positive. Yellin (2006) indicated that 40 percent of new HIV cases which are diagnosed in women in the US are African American. He also found out that women of the African-American origin are 23 times more likely to be found with HIV compared to white women. This shows that African American women are the most affected group by HIV among all racial groups in the USA making their exposure to HIV and AIDS high and more frequent. Prejudices The high rate of incarceration and violent deaths has led to high loss of African American men which has then resulted in sex ratio imbalance. This situation has rendered African American women less powerful and in control to negotiate safer relationships. Women have significantly altered their self-protective behaviors in a way that are driven by fear of losing their partners. African American women also experience stigmatization and internalized oppression as a result of racism, sexism, and class exploitation. These forms of stigmatization make these women inhibit disclosure of their HIV status. These forms of discrimination and stigmatization within the African American population may explain why African American women continue to be one of the groups hard hit by HIV pandemic with diagnosis rates rising as twice as much compared to the white community. Also, the social status and geographical location of African American women affect their risk for HIV. Previously, researchers have linked inequalities of class, race/ethnicity, sexuality and gender with the distribution rate of HIV infection. One of the most important factors that CHNs should consider when drafting their intervention strategies is African American culture. Forms of resiliency This population has been very resilient due to various factors and reasons. African American adolescents have significantly benefited from culturally-appropriate risk reduction interventions. It is important for community health nurses to engage these adolescents in education and counseling sessions which are both gender and culturally specific, and should incorporate modules on HIV transmission, healthy relationships, condom usage, and effective communication skills. The intervention strategies that produce a greater reduction in high-risk behaviors are strategies that appeal to the cultural sensitivity of such at-risk populations. It is necessary to change both the behavior of these individuals as well as their social networks and communities if nurse intervention strategies are to bear fruits. The interventions and public health initiatives to address the problem of HIV has to be long-term rather that short-term. Therefore, community health nurses have to look 10 to 30 years ahead for ways to prevent the spread of HIV among this group. Intervention will help bridge the gap between individuals who HIV negative, HIV positive, and those infected with HIV. Community Programs This section is going to discuss two of the most effective community programs available for HIV/AIDs population among the African American women. Over the years, these programs have helped numerous African American women with HIV/AIDs in the United States. SisterLove Inc. SisterLove Inc. Is one of the community programs based in Atlanta focused on helping the African American women affected by HV/AIDs. The group also addresses HIV-related disparities affecting African American women. CDC has recognized SisterLove as one of the most effective programs in reducing HIV-related disparities among the African American women in the United States (CDC, 2014). The program also addresses the shared cultural aspects of African American women’s experiences that usually affects their vulnerability to HIV infection. Peers Reaching Out and Modeling Intervention Strategy (PROMISE) PROMISE represents one of the community-led programs that have achieved great success in reducing HIV risk among the African American population. This program recruits people who have been diagnosed with HIV to act as role models who disseminate materials and information to their peers who are also HIV-positive to help them move towards safer practices. Nursing Implications Primary Both the young and older African American women are contracting HIV infections at very high rates. However, little attention is being given towards their prevention needs. Teaching and counseling the two sub-groups of women is imperative to reduce the incidences and the transmission of HIV among the two sub-groups. It is the role of community health nurses engaged with African American women with HIV to employ strategies that will prevent the HIV negative African American women from getting infected with the disease. A significantly large number of HIV negative women are living and interacting with the HIV positive women. The highest at risk age-group is the adolescent girls. Educational and counseling initiatives must be increased among this age-group to increase their understanding of the importance of abstinence or safe sexual practices. Sexual practices are not the only way that these girls are contracting the disease – this group is contracting the disease through other means, including injections for those who are into drug abuse which is also considered to be one of the greatest risk-factors in this group. Lack of enough attention on risk factors such as gender roles, gender inequalities, promiscuity among the African American women, and substance abuse poses major challenges that prevent African American women from participating in HIV community programs. A significant number of African American women who are into promiscuity and prostitution were abused during their childhood stages. In turn, these women turn to drugs and alcohol. Drugs and alcohol impair the ability of these women to function well in all areas of their lives, including engaging in behaviors that are risky thus exposing themselves to HIV/AIDS. Nurses should also extend their prevention initiatives to African American women who are over 49 years old because HIV infection rate among the women of this age group has been found to be high. Women who are in this age group fail to see themselves as at risk for HIV; therefore, they do not take necessary precautions to prevent its transmission. Women in this age-group avoid using condoms because they no longer fear getting pregnant; therefore, nurses should advise these women always to use condoms to prevent themselves from contracting HIV. Secondary Secondary prevention Community health nurses should encourage African American women to go for HIV tests to know their HIV status earlier enough for early interventions. Data and information on those who are infected will help nurses identify the extent of the problem and formulate appropriate intervention strategies earlier enough. There are two ways in which nurses can use to help African American women who have just been diagnosed with HIV/AIDS. First, nurses should use strategies of helping these women accept their status, counsel them, and encourage them. Over the past, spirituality has historically served important role within this community’s culture, including survival, coping, improvement of health outcomes, and maintenance of overall well-being (Dalmida, Holstad, Dilorio & Laderman, 2012). Women who are HIV-positive women view spirituality as one of the most important resources for helping them cope with the stress factors and problems associated with their status (Bosworth, 2006). Therefore, nursing intervention among women with HIV should incorporate the spirituality aspect. Spirituality helps improve the health-related quality of life and immune function among these women. After finding out that they are HIV-positive, people go through a challenging time trying to cope with their changed health status and the reality of their situation. Tertiary prevention For those women whose HIV status is highly advanced, it is the role of the nurse to explain the action of each antiretroviral drug and instill knowledge for individual’s self-administration. This includes strong precautions about rigidly adhering to the dosage, time, and frequency of drug administration to avoid development of drug resistance. Describing the side effects of drug therapy to these women is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing nurse. The nurse should arrange appointments for laboratory tests for monitoring the effects of drug therapy among this group. Individuals who are HIV positive need to eat a good diet. Most of African Americans who are HIV positive live in regions which have a high poverty rate. Therefore, it is necessary that community health nurses who are engaged in intervention strategies to incorporate the economic factor, that is, how they can contribute to increasing the economic status of African American women living with HIV/AIDS. Another perspective of helping those whose HIV infections have reached advanced levels is to help them redefine themselves and find meaning in life (Smith & Liehr, 2013). Greater life purpose is associated with higher resilience, communication efficiency, and optimism. Nurses can, therefore, help these women understand and value their life thereby improving their resilience. There is a close relationship between spirituality and well-being in HIV-positive African American women. Therefore, nurses can approach this problem through logotherapy where they can help these women see life in terms of solutions rather than seeing it in terms of problems; focusing on goals rather than obstacles; having a holistic view rather than reductionistic view; and emphasizing on discovering rather than uncovering. Logotherapy can help African American women whose HIV status is highly advanced separate themselves from their symptoms and arouse the dynamic power of human spirit. Helping them find meaning will facilitate awareness of their subconscious commitments and beliefs and enable them discover their values. Frankl (1969) described three logotherapeutic approaches, including dereflection, paradoxical intention, and Socratic dialogue. This paper suggests that nurses should approach this problem through paradoxical intention and Socratic dialogue. Through paradoxical intention approach, the nurses will help the women to confront their anxieties and fears. It will strengthen their capacity to self-distance. Another approach is the Socratic dialogue which includes the conversation of questions and answers, probing deeply into existential issues such as one’s values. Such rhetorical debates trigger a change in attitude, behavior or both. It helps a person to discover himself/herself. The nurse poses questions so that the affected persons can become aware of their unconscious decisions, their un-admitted self-knowledge, and their repressed hopes. Through this approach, the nurse and the infected person will explore the person’s past experiences as well as her fears for the future. Both the paradoxical intention and Socratic dialogue provide tools to tap into inner resources to emerge as a stronger and more joyous self. Conclusion In conclusion, it is clear that women are among the vulnerable population in the USA. More so when the women are from the African –American origins and are HIV positive, they encounter enormous challenge in their daily lives. Their HIV statuses are made worse by a number of factors, including poverty and limited resources, limited access to health care and limited HIV prevention education. Appropriate responsive measure by the nursing practitioners taking care of the HIV positive African American using the above discussed ways will help them live a better life and a comfortable one. Failure to provide this intervention will only worsen the situation. The intervention should be long-term and cover all aspects of nursing intervention, including the primary, secondary, and tertiary prevention.

References Bosworth H. (2006). The importance of spirituality/religion and health-related quality of life among individuals with HIV/AIDS. Journal of General Internal Medicine, 21(5), S3–S4. Centers for Disease Control and Prevention. (2011a). Fact sheet: HIV among African Americans. Retrieved from 	http://www.cdc.gov /hiv/topics/aa/PDF/aa.pdf Dalmida, S. G., Holstad, M. M., DiIorio, C., & Laderman, G. (2012). The Meaning and Use of Spirituality Among African American Women Living With HIV/AIDS. Western Journal of Nursing Research, 34(6), 736–765. http://doi.org/10.1177/0193945912443740 Frankl, V. (1969). The Will to Meaning. New York: New American Library Ragsdale–Hearns, B. (2012). A Study of the Lack of HIV/AIDS Awareness Among African American Women: A Leadership Perspective. Bloomington: Trafford Publishing Smith, M. & Liehr, P. (2013). Middle Range Theory for Nursing: Third Edition. New York: Springer Publishing Company Yellin, T. (2006). ‘Out of Control: AIDS in Black America’ A Special Edition of ‘Primetime’ [Review of the documentary “Out of Control: AIDS in Black America]. ABC News Internet Ventures. Retrieved from http://abcnews.go.com/Primetime/Story?id=2346857&pa

vulnerable population
Running Head: Vulnerable population

Name: Institution: Date:

Definition and Identification Over the years, HIV has killed millions of people around the world. African Americans living in the United States represent one of the groups that are adversely affected by HIV. Human immunodeficiency virus (HIV) refers to a virus that attacks one’s immune system which represents the natural defense system of a human body. When this defense system becomes weak, the body becomes susceptible to various diseases and infections. The virus that attacks the immune system as well as the infection that affects the body as a result of the weak immune system is called HIV. In 2014 alone, 5,128 African American women were diagnosed with HIV compared to 1,483 white women and 1,350 Latino/Hispanic women in the USA (CDC, 2016). This study is going to investigate the problem of HIV among this vulnerable population. The study will also investigate the risk factors of HIV among this population. Finally, the study is going to discuss the nursing implications. Problems, Susceptibility, Exposures and Frequency An earlier report by Global-Campaign in 2006 indicated that of the total population of the United States, African Americans only account for 13 percent. However, African Americans account for more than half of all the new HIV cases in the U.S. especially the women, making them a vulnerable community (Ragsdale-Hearns, 2012). This high frequency rates among them is due to various problems and high exposures to HIV/AIDS. For instance, African American heavily inhabited areas in the USA are known for high rates of drug abuse and poverty. Due to the high instances of drug abuse, needle sharing among the drug users is common due to poverty hence in the process HIV transmission through contaminated needles is common. Some of the young African Americans are also naïve and hence ignorant when it comes to their sex life. Some are promiscuous and due to their ignorance and (or) lack of knowledge on how to engage in safe sex, end up being infected. African-American women have a high frequency of being infected with HIV/ AQIDS. In fact, according to (CDC, 2014), African American women are 23 times more likely to be found with HIV compared to white women. Prejudices HIV positive African American women usually experience high instances of prejudices due to their HIV status. The stigmatization has been termed by researchers as one contributory factor that leads to denial among the ones infected with the disease which results to suicidal cases among them. For instance in the workplaces, some people have been reportedly sacked by their employers once their HIV status is known. If they are looking for employment from a potential employer, it is difficult for them to be employed. These kinds of stigmatization and internalized oppression as a result of racism, sexism, and class exploitation make these women reluctant to disclose their HIV status ("CDC Works 24/7," 2016). Forms of resiliency This population has been very resilient due to various factors and reasons. African American adolescents have significantly benefited from culturally-appropriate risk reduction interventions. It is important for community health nurses to engage these adolescents in education and counseling sessions which are both gender and culturally specific, and should incorporate modules on HIV transmission, healthy relationships, condom usage, and effective communication skills (Hunter, 2006). The intervention strategies that produce a greater reduction in high-risk behaviors are strategies that appeal to the cultural sensitivity of such at-risk populations. It is necessary to change both the behavior of these individuals as well as their social networks and communities if nurse intervention strategies are to bear fruits. The interventions and public health initiatives to address the problem of HIV has to be long-term rather than short-term. Therefore, community health nurses have to look 10 to 30 years ahead for ways to prevent the spread of HIV among this group (Ragsdale–Hearns, 2012). Community Programs This section is going to discuss two of the most effective community programs available for HIV/AIDs population among the African American women. Over the years, these programs have helped numerous African American women with HIV/AIDs in the United States. SisterLove Inc. SisterLove Inc. Is one of the community programs based in Atlanta focused on helping the African-American women affected by HIV/AIDs. The group also addresses HIV-related disparities affecting African American women. CDC has recognized SisterLove as one of the most effective programs in reducing HIV-related disparities among the African American women in the United States (CDC, 2014). The program also addresses the shared cultural aspects of African American women’s experiences that usually affects their vulnerability to HIV infection. Peers Reaching Out and Modeling Intervention Strategy (PROMISE) PROMISE represents one of the community-led programs that have achieved significant success in reducing HIV risk among the African American population. This program recruits people who have been diagnosed with HIV to act as role models who disseminate materials and information to their peers who are also HIV-positive to help them move towards safer practices ("PROMISE for HIP", 2016). Nursing Implications Primary Both the young and old African American women are contracting HIV infections at very high rates. However, little attention is being given towards their prevention needs. Teaching and counseling the two sub-groups of women is necessary so as to reduce the incidences and the transmission of HIV among the two sub-groups. It is the role of community health nurses engaged with African American women with HIV to employ strategies that will prevent the HIV-negative African American women from getting infected with the disease (Hunter, 2006). A significantly large number of HIV negative women are living and interacting with the HIV-positive women. The highest at risk age-group is the adolescent girls. Educational and counseling initiatives must be increased among this age-group to increase their understanding of the importance of abstinence or safe sexual practices. Sexual practices are not the only way that these girls are contracting the disease. This group is contracting the disease through other means, including injections for those who are into drug abuse. This is considered to be one of the greatest risk factors in this group. Lack of enough attention on risk factors such as gender roles, gender inequalities, promiscuity among the African American women, and substance abuse poses significant challenges that prevent African American women from participating in HIV community-based programs. A significant number of African American women who are into promiscuity and prostitution were abused during their childhood stages. In turn, these women turn to drugs and alcohol. Drugs and alcohol impair the ability of these women to function well in all areas of their lives, including engaging in behaviors that are risky thus exposing themselves to HIV/AIDS (Hunter, 2006). Nurses should also extend their prevention initiatives to African American women who are over 49 years old because HIV infection rate among the women of this age group has been found to be high. Women who are in this age group fail to see themselves as at risk for HIV; therefore, they do not take necessary precautions to prevent its transmission. Women in this age-group avoid using condoms because they no longer fear getting pregnant. Therefore, nurses should advise these women always to use condoms to prevent themselves from contracting HIV.

Secondary Secondary prevention Community health nurses should encourage African American women to go for HIV tests to know their HIV status earlier enough for early interventions. Data and information on those who are infected will help nurses identify the extent of the problem and formulate appropriate intervention strategies earlier enough. There are two ways in which nurses can use to help African American women who have just been diagnosed with HIV/AIDS. First, nurses should use strategies for helping these women accept their status, counsel them, and encourage them. Over the past, spirituality has historically served a major role within this community’s culture, including survival, coping, improvement of health outcomes, and maintenance of overall well-being (Dalmida, Holstad, Dilorio & Laderman, 2012). Women who are HIV-positive women view spirituality as one of the most important resources for helping them cope with the stress factors and problems associated with their status (Bosworth, 2006). Therefore, nursing intervention among women with HIV should incorporate the spirituality aspect. Spirituality helps improve the health-related quality of life and immune function among these women. After finding out that they are HIV-positive, people go through a challenging time trying to cope with their changed health status and the reality of their situation. Tertiary prevention For those women whose HIV status is in the critical stages, it is the role of the nurse to explain the action of each antiretroviral drug and instill knowledge for individual’s self-administration. This is done by advising the on the importance of adhering to the time of taking the dose, the dosage amount, frequency of drug administration. When effectively educated on how to use the drugs, instances of drug resistance by the body are averted. Describing the side effects of the medication to these women is essential so that they can understand how their bodies respond to the treatments (Bosworth, 2006). The nurse should arrange appointments for laboratory tests for monitoring the effects of drug therapy among this group. Individuals who are HIV positive need to eat a good diet. Most of African Americans who are HIV positive live in regions which have a high poverty rate. Therefore, it is necessary that community health nurses who are engaged in intervention strategies to incorporate the economic factor (Harlan, n.d.). Another perspective of helping those whose HIV infections have reached advanced levels is to help them redefine themselves and find meaning in life. Greater life purpose is associated with higher resilience, communication efficiency, and optimism. Nurses can, therefore, help these women understand and value their life thereby improving their resilience. There is a close relationship between spirituality and well-being in HIV-positive African American women. Therefore, nurses can approach this problem through logotherapy. Here, the nurses help these women see life in terms of solutions rather than seeing it in terms of problems. Therefore, they focus on goals rather than obstacles, having a holistic view rather than reductionistic view and emphasizing on discovering rather than uncovering (Smith & Liehr, 2013). Logotherapy can help African American women whose HIV status is highly advanced separate themselves from their symptoms and arouse the dynamic power of their human spirit. Helping them find meaning will facilitate awareness of their subconscious commitments and beliefs and enable them to discover their values. (Frankl, 1969) described three logotherapeutic approaches, including dereflection, paradoxical intention and Socratic dialogue. This paper suggests that nurses should approach this problem through paradoxical intention and Socratic dialogue. Through paradoxical intention approach, the nurses will help the women to confront their anxieties and fears. It will strengthen their capacity to self-distance. Another approach is the Socratic dialogue which includes the conversation of questions and answers, probing deeply into existential issues such as one’s values. Such rhetorical debates trigger a change in attitude, behavior or both. It helps a person to discover himself/herself. The nurse poses questions so that the affected individuals can become aware of their unconscious decisions, their un-admitted self-knowledge, and their repressed hopes. Through this approach, the nurse and the infected person will explore the person’s past experiences as well as her fears for the future. Both the paradoxical intention and Socratic dialogue provide tools to tap into inner resources to emerging as a stronger and more joyous self. Conclusion In conclusion, it is clear that women are among the vulnerable population in the USA. More so when the women are of the African –American origins and are HIV positive, they encounter an enormous challenge in their daily lives. Their HIV statuses are made worse by some factors, including poverty and limited resources, limited access to health care and limited HIV prevention education. Appropriate responsive measure by the nursing practitioners using the above-discussed ways will help them live a better life and a comfortable one. Failure to provide this intervention will only worsen the situation. The intervention should be long-term and cover all aspects of nursing intervention, including the primary, secondary, and tertiary prevention (Hunter, 2006). References Bosworth H. (2006). 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