Vulnerable population

Running Head: Vulnerable population

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Vulnerable population

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 ones 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

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hence in the process HIV transmission through contaminated needles is common. Some of the
young African Americans are also nave 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

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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 (RagsdaleHearns, 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 womens experiences that usually affects their vulnerability to HIV infection.

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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 HIVnegative 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.

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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 agegroup 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

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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 communitys culture,
including survival, coping, improvement of health outcomes, and maintenance of overall wellbeing (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 individuals selfadministration. 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.

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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 ones values.

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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 persons 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). The importance of spirituality/religion and health-related quality of life
among individuals with HIV/AIDS. Journal of General Internal Medicine, 21(5), S3S4.
CDC Works 24/7. (2016). Centers for Disease Control and Prevention. Retrieved 21 July 2016,
from http://www.cdc.gov/

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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), 736765. http://doi.org/10.1177/0193945912443740
Frankl, V. (1969). The Will to Meaning. New York: New American Library
Harlan, C. Global health nursing.
Hunter, S. (2006). AIDS in America. New York: Palgrave Macmillan.
RagsdaleHearns, B. (2012). A Study of the Lack of HIV/AIDS Awareness Among African
American Women: A Leadership Perspective. Bloomington: Trafford Publishing
PROMISE for HIP. (2016). Effectiveinterventions.cdc.gov. Retrieved 21 July 2016, from
https://effectiveinterventions.cdc.gov/en/highimpactprevention/Interventions/PROMISE.a
spx
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

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