Running head: HEALTH ADVOCACY CAMPAIGN 1

Running head: HEALTH ADVOCACY CAMPAIGN 1 Developing a Health Advocacy Campaign Student Walden University NURS6050, Section 3, Policy and Advocacy for Population Health Date

HEALTH ADVOCACY CAMPAIGN 2 Developing a Health Advocacy Campaign It is estimated that nearly 500,000 people in the United States are living with acquired immune deficiency syndrome (AIDS) and 1.2 million are infected with the etiologic agent of this disease, human immunodeficiency virus (HIV) (Moss, 2013). Although major advances have been made in disease prevention, education, and management, including antiretroviral therapy, one person in the US becomes infected with HIV every ten minutes (Moss, 2013). I believe that this data signifies a need for improved screening and prevention programs and initiatives. Starr and Bradley-Springer (2014) identified numerous barriers that may hinder persons from seeking testing and care that include the following: cost, denial, inconvenience, lack of transportation, and fear of stigma. My health advocacy campaign entitled, Red Bus Clinic, is sensitive to and addresses such concerns. The primary goal of this initiative is to increase HIV screening throughout the US. In addition, the campaign hopes to increase the number of individuals seeking treatment. I think this campaign will be successful as it follows many attributes of other advocacy programs and initiatives proven effective, which will later be explained in detail. Laws and regulations regarding mandated reporting of HIV and AIDS vary throughout the US (Gostin & Webber, 1998). Obermeyer, Baijal, and Pegurri (2011) explain that some may feel a violation of privacy and stigmatization if this sensitive health information is disclosed, consequently resulting in delayed treatment and prevention. Many ethical questions and dilemmas have surfaced related to this conflict. My campaign aims to develop a momentary national policy that would omit disclosure laws and regulations exclusively for the Red Bus Clinic. This will make it easier to run the bus and allow for completely confidential testing while

HEALTH ADVOCACY CAMPAIGN 3 in operation. The purpose of this paper is to discuss attributes of efficacious advocacy campaigns, the Red Bus Clinic campaign, and the initiative s policy implementation process. Effective Advocacy Programs What makes a health advocacy campaign effective and successful can be extensively debated. As I have previously learned, several variables can influence the success of an initiative, such as goals, resources, leadership, teamwork, collaboration, and so forth. The FLU- FIT Program and Breast Care Express are two examples of advocacy initiatives that have been recognized as effective. The FLU-FIT (FLU indicates influenza vaccine) Program utilized community influenza vaccination clinics to additionally screen for colorectal cancer (Potter et al., 2011). Individuals between ages 50 and 80 years were provided with a fecal immunochemical test (FIT) while receiving their annual influenza vaccine (Potter et al., 2011). Potter et al. (2011) shared that of the 1447 (51.4%) FIT eligible participants, 653 (45.1%) completed the test within 90 days. Researchers found that individuals were 2.76 times more likely to complete a FIT as compared to those who were not offered testing kits (Potter et al, 2011). I believe that the convenience of receiving a FIT test at the annual clinic contributed to the program s success. Additionally, I think that individuals that participate in influenza vaccine clinics have a desire to be healthy and consider screening as beneficial to their health. The Breast Care Express was created in 2004 by the Swedish Breast Centers (Brown, 2013). This traveling health screening clinic continues to provide cost-effective full-service mammography to women residing in both suburban and rural areas of Seattle, Washington (Brown, 2013). Brown (2013) shared that in a period of five years (2007 to 2012) the Swedish Breast Care Express screened 40,636 patients and identified 163 cancers. Screening numbers,

HEALTH ADVOCACY CAMPAIGN 4 collaboration, ongoing positive community feedback, and continued donations serve as evidence of the clinic s success (Brown, 2013). Once again, I believe the convenience factor acts as a major incentive for this targeted group. The Red Bus Clinic Like the FLU-FIT Program and Breast Care Express Clinic, the Red Bus Clinic revolves around convenience for the consumer. Services are free, but any monetary donations are appreciated. The campaign is a confidential health screening resource and initiative, which aims to increase HIV and AIDS testing rates in Minnesota. In order to qualify for services, individuals must provide valid photo identification proving they are 18 years of age or older. The clinic is transportable, red in color, and will travel to several locations throughout the state identified as high-risk by sources such as the Centers for Disease Control and Prevention (CDC). Locations will also include several college campuses and heavily populated cities. Clinic operation will begin late spring and end in the middle of summer, about three months long. The reason for this time period is largely due to the climate and winter weather conditions in the state. People are more likely to be outside and able to visualize the clinic in the warmer months. Currently, there are three methods of HIV screening tests are available: rapid HIV testing at patient point of care, laboratory testing at a health care facility, and over-the-counter home testing kits (Burgess & Kasten, 2013). Although home testing kits are available in the state of Minnesota, I believe that cost and the lack of available counseling are barriers for many. The Red Bus Clinic will primarily utilize rapid oral HIV testing. In the event of a positive result, the test will be confirmed with a rapid finger-stick test. Success of the campaign would be measured by the screening rates in each area and a noted elevation in the number of individuals seeking treatment that year. Treatment data will be

HEALTH ADVOCACY CAMPAIGN 5 obtained from resources such as the CDC. Positive community feedback would also be an indicator of success. State Reporting and Disclosure Requirements There is a great amount of research and debate regarding the ethical dilemmas associated with mandatory reporting of communicable diseases such as HIV and AIDS, which will later be discussed. In Minnesota, state law mandates physicians, health care institutions, and laboratories to report infectious disease to the state s health department (Minnesota Department of Health [MDH], 2013). The MDH (2013) also states: Unless previously reported, every other licensed health care provider who provides care to any patient who has, is suspected of having, or has died from a reportable disease is required to report (para. 2, Persons Required to Report Disease section). These policies are most likely to impact advocacy efforts in which my campaign hopes to change. Politics and the Legislative Process Nursing s Social Policy Statement states, Public policy and the health care delivery system influence the health and well-being of society and professional nursing (as cited in Milstead, 2013, p. 46). In contrast to this notion, nurses, especially advanced practice nurses, have the power to influence and shape both public policy and the health care delivery system. Milstead (2013) discusses three identities of power, which include coercion, persuasion, and manipulation. The Red Bus Clinic campaign will focus largely on persuading lawmakers to achieve the group s desired policy temporarily allowing the exclusion of mandatory reporting of a positive HIV or AIDS test to the state s department of health. Expertise, networks, and money are the three instruments involved in the legislative process (Milstead, 2013). In addition

HEALTH ADVOCACY CAMPAIGN 6 to such tools, nurses can utilize the three legs of lobbying to enhance the likelihood of success for the policy s implementation. To begin, nurses must first understand how a bill is developed. For many, lawmaking and policy implementation can be a difficult and complex process to comprehend. According to Milstead (2013), knowing one s resources can sometimes be most helpful in legislation. Collaborating and establishing close ties with policy makers, lobbyists, interest groups, and other networks is one of the first steps the Red Bus Clinic campaign will take. In particular, the campaign will seek relationships with politicians and groups most interested in the subject of health care and HIV and AIDS. Requesting support from the ANA and its state constituent associations and other specialty nursing groups would also be a top priority to aid in policy development. I believe the ANA would be one of the campaign s greatest resources as it supports voluntary, confidential, and anonymous HIV testing along with informed consent and pre- and post-test counseling (ANA, 1991). The ANA is responsible for significant investments in professional lobbying efforts, which also acts a component of the first leg of lobbying (as cited in Milstead, 2013). Milstead (2013) describes leg two as involving the use of grassroots lobbying. This type of lobbying utilizes constituents with the ability to elect officials through their vote (Milstead, 2013). The process would include in-person visits, personally written letters, phone calls, emails, and fax messages (Milstead, 2013). Such outreach efforts would also be a great way to advertise and promote the Red Bus Clinic and seek additional support. Perhaps the most difficult obstacle of this campaign will be funding. The component of money acts as the third leg of effective lobbying (Milstead, 2013). This campaign will be funded chiefly from grants and monetary donations. The Health Resources Services Administration and

HEALTH ADVOCACY CAMPAIGN 7 the Health Care Financing Administration are two of the leading national organizations in providing support for HIV care (CDC, YEAR). Seeking funding assistance from such groups would be beneficial for campaign efforts. Collaboration with the National HIV/AIDS Strategy (2010), the United States first comprehensive coordinated roadmap; would also serve as a great resource in seeking financial support. Ethical Considerations I believe the most significant ethical dilemma of the Red Bus Clinic will be concerns related to not reporting a positive test. The campaign s response is our initiative statement: to increase screening rates across the state and numerical data of HIV or AIDS positive individuals seeking medical treatment. If someone does test positive for HIV or AIDS, the individual will be required to meet with a dedicated medical staff member trained in counseling to discuss disease education, treatment referrals, and the importance of informing partners. A second ethical consideration is how the privacy and confidentiality of patients will be maintained and upheld. As stated previously, testing will be completely confidential. Conversely, some may feel that by walking in the clinic they may be viewed as having HIV or AIDS. Flyers will be distributed throughout the state with tour dates and times to help advertise and gain campaign awareness. If an individual were too uncomfortable to seek testing within his or her community, this person could travel to a different location. The Red Bus Clinic also plans to offer information about HIV and AIDS to the public in the form of educational pamphlets created by the program s staff. By doing so, the campaign hopes to decrease stigmatization that is often associated with the disease.

HEALTH ADVOCACY CAMPAIGN 8 Summary In summary, the importance of HIV and AIDS screening cannot be underemphasized. Although access to screening and counseling has increased, many people living in low- and middle-income areas do not know there serostatus (Moss, 2013). Burgess and Kasten (2013) explain that appropriate screening can allow for beneficial care in the long-term for the individual patient and potentially reduce the risk of transmission to others. Janssen et al. (2001) states, Individuals who have early knowledge of their HIV infection can benefit from prophylaxis for opportunistic infections; treatment of STDs, substance abuse, and mental health conditions; access to social services; and, when appropriate, use of combination antiretroviral therapy (p. 1020). It is also known that individuals who are aware that they are infected with the disease are substantially more likely to make efforts to protect partners than when they were unaware (Janssen et al., 2001). The Red Bus Clinic will allow for completely confidential HIV and AIDS screening at no cost made possible through grants and monetary donations. The Red Bus Clinic campaign seeks to momentarily eliminate mandatory reporting regulations while in operation. The FLU-FIT Program and Breast Care Express are both examples of successful and effective advocacy initiatives. In my opinion, the convenience factor is what made these programs efficacious. The Red Bus Clinic initiative is also centered on convenience for the consumer. Ethical dilemmas related to privacy and confidentiality are specific to this population and are addressed by this campaign. Nurses must not only understand, but also abide by the legal, ethical, and regulatory aspects of health care. The American Nurses Association s Position Statement on HIV Testing (1991) supports voluntary, confidential, and anonymous testing along with informed consent and

HEALTH ADVOCACY CAMPAIGN 9 pre- and post-test counseling. Informing and influencing Minnesota legislature with the support of groups such as the ANA would be the first step in accomplishing this political action. References A long list of appropriate references was provided