CommunityDiagnosis:Afro-Caribbean Aged18-29 Years
Thepurposeof thepresentcommunitydiagnosiswasto identifyareasof needforhealthpromotionamong theAfro-Caribbean youthsaged18-29 years.Thedata forcommunitydiagnosiswasobtainedfrom thedatabase of thePublic Health Agency of Canada andCanadian Women’s Health Network. Afro-Caribbean makesup 2.5 % of theCanadian population,where57 % of them residein Ontario. Loweducationalattainment,thelackof socialnetworksthat addresstheneedsof Afro-Caribbean, andincomeinequalitiesare thekeydeterminants of healththat haveincreasedtheriskof HIV infectionamong theselectedaggregate.Thehealthchallengeof HIV infectionamong theAfro-Caribbean youthsmanifests in thethrough substanceabuse,increasesin casesof mentalillness,anda highdeathrateof membersof theaggregatecomparedto otherracialgroups.
Keywords:Community diagnosis,aggregate,determinants of health.
CommunityDiagnosis:Afro-Caribbean Aged18-29 Years
Communitydiagnosisis s criticalprocessthat determinessomeof thepatternsof healthchallengesthata givencommunityisfacedwith, includingspecificfactorsthat influencethispattern.Shrestha (2014) definedcommunitydiagnosisas a comprehensiveevaluation of healthstatusof a givencommunityin relationto its physical,social,andbiologicalenvironment.Thispaperdescribesthecommunitydiagnosisactivitieswith a focuson Afro-Caribbean aged18-29 yearslivingin Ontario. Thepaperwill document thethree keyhealthdeterminants andthehealthassessmentof theselectedaggregate(Afro-Caribbean aged18-29 years)based on thethree determinants of health.Thecommunitydiagnosiswill be based on thePopulation Health Promotion Model, which indicatesthefullrangeof healthdeterminants, differentlevels of action,andcomprehensiveactionstrategies(Public Health Agency of Canada, 2015).AlthoughAfro-Caribbean aged18-29 yearslivein one of theworld’sdevelopedcountries(Canada), lowincome,loweducationalattainment,andlimitedsocialsupportnetworksare thekeychallengesandfactorsthat determinetheir health.
About 4,348 were diagnosed with HIV in Ontario between 1985 and 2011.
About 51 % of the 4,348 cases were female
About 20 % of all cases of HIV / AIDs diagnosis are Afro-Caribbean
Afro-Caribbean makes up to 2.5 % of the Canadian population where 57 % of them live in Ontario.
Afro-Caribbean aged 15-25 years are 25 % and those that are within the age group 25-34 are 31.2 % of the total population of Afro-Caribbean.
About 24 % of Afro-Caribbean aged between 15 years and above have less than high school certificate.
Afro-Caribbean background aged 25 years and above and earn an average employment income of about $ 29,700 while the white Canadians who earn $ 37,200 annually.
HIV-related deaths of the Afro-Caribbean women account for about 32 % of all deaths that result from HIV / AIDs in Ontario.
Dueto the limitation of time, this community diagnosis could utilize anassessment method that would require the field study. The presentcommunity diagnosis relied on thedatabases of thegovernmentagenciesandcrediblenon-governmental agencieswereusedas themajorsourcesof data. Examplesof theseagenciesincludethePublic Health Agency of Canada andCanadian Women’s Health Network. However, the diagnosis suggeststhe use of a survey assessment method, which will facilitate thecollection of data from the aggregate instead of relying on thedatabases. A community survey should be followed by a review ofdifferent data sets as well as the evaluation of resources in thetarget community.
Suggestedmethod of including aggregate in data collection and communitydiagnosis
Acommunity diagnosis should be considered as scientific random.Therefore, a purposeful sampling is suggested as the most suitablemethod of included respondents from the aggregate community. A surveymay be conducted on a 100 Afro-Caribbean Aged18-29 Years,where a questionnaire should be used as an effective survey tool tocollect data.
Aggregateassessment and data analysis
HIV/ Aids among Afro-Caribbean
HIVinfectionaffectsindividualsirrespective of their races.However,studieshaveindicatedthatAfro-Caribbean is themostaffectedby HIV / Aids endemic in Ontario andCanada at large.Accordingto CACVO (2013) about4,348 werediagnosed with HIV in Ontario between 1985 and2011. About51 % of the4,348 caseswerefemale,which indicatesthatthefemaleresidentsof Ontario are at a higherriskof gettinginfectedwith HIV than their malecounterparts.The4,348 newcasesof infectionconstitute about 13 % of thetotalcasesof HIV patientsin Canada. TheLaboratory Enhancement Program reportedindicatedthatabout 9.5 % of thegays in Ontario are Afro-Caribbean, whereHIV infectionfollowssimilarpatterns(CACVO, 2013).
SimilarstudieshaveshownthattheAfro-Caribbean havebecomethemajorcomponentof theHIV endemic in Ontario. Forexample,about 70 % of thetotalmaternalinfectiontransmissionsreportedin Ontario between 1994 and1996 occurredamong theAfro-Caribbean women(The Canadian Institute ofHealth Research, 2015). Thisaccountedforabout32 % of thetotalnumberof HIV / AIDs deathsamong womenin Ontario. Recentstatistics indicatethatthesetrendshavenot changed.Currently, about 20 % of allcasesof HIV / AIDs diagnosisare Afro-Caribbean (Solomon & Mishra, 2014). In addition,casesof newinfectionsamong theAfro-Caribbean communityhas beenincreasingat a highrateof about13.1 % everyyearandithas risenby about85 % within thelastfive years.Surprisingly, thelargestproportion(about 59 %) of infectionoccurredafter theaffectedpersonsstartedlivingin Ontario. Althoughthesestatistics donot specifytheHIV prevalencein theagegroupof 18-29 years,mostof theseinfectionsare reportedfortheyoungpeopleagedbetween 18-35 yearsandlivingin Ontario. Itis evidentthatHIV / AIDs is themajorhealthissueaffectingthelivesof Afro-Caribbean aged18-29,especiallythosewholivein Ontario.
Themainfocusof thiscommunitydiagnosisprojectis thepopulationof Afro-Caribbean whoisagedbetween 18 and29 yearsandwholivesin Ontario, Canada. In total,itis estimatedthattheAfro-Caribbean makesup to 2.5 % of theCanadian populationwhere57 % of them livein Ontario (PHAC, 2015). Afro-Caribbean makesup about16 % of theminoritypopulation,which makesAfro-Caribbean thethirdlargestvisibleminoritygroup.Althoughthiscommunitydiagnosisfocuseson thepopulationaged18-29 years,theavailablecensusdata dospecifythesizeof thisagegroup,which one of thecurrentdatagaps.However,thedata reportedinthePublic Health Agency of Canada (2014) indicatedthatAfro-Caribbean aged15-25 yearsare 25 % agegroup25-34 is 31.2 % of thetotalpopulationof Afro-Caribbean. Thedata showthatthemajorityof Afro-Caribbean is youngpeoplelivingin theurbanareas.About54 % of theAfro-Caribbean are descendants of thefirstgenerationwhiletherestareconsideredas immigrants.
Factorsthatareetiologically relatedto theHIV problem
Thehighrateof prevalenceof HIV / AIDs among theAfro-Caribbean youthslivingin Ontario arecausedby three determinants of health,namelyloweducationattainment,lowincome,andthelackof socialsupportnetworks.
Afro-Caribbeanyouthslivingin Ontario seemto bedisadvantagedin nearlyallaspectsof life,includingtheaccessto education.Nearlyallpublicationsthat focuson theattainmentof educationin Canada, andOntario to be specific,agreethattheAfro-Caribbean are themostaffectedgroup,whereveryfewof them accesshighereducation.Accordingto PHAC (2014) about 24 % of Afro-Caribbean agedbetween 15 yearsandabove (thisincludesthosewhoareagedbetween 18-29 years)havelessthan highschoolcertificate.In addition,a smallerproportion(12.7 %) of Afro-Caribbean aged15 yearsandabovehas a universitydegreeas comparedto 15.4 % of theentireCanadian population(PHAC, 2014). Studiesalsoshowthatabout 20 % Afro-Caribbean immigrantshaveuniversityeducationcomparedto thenationalaverageof immigrantswith universitydegrees(PHAC, 2014). Therefore,Afro-Caribbean, both thefirstgenerationandrecentimmigrants,haveloweducationattainmentcomparedto othergroupsformingtheOntario population.
Althoughthegovernmentof Canada managedto formulateanti-racist policiesthat encouragedtheimmigrationof Afro-Caribbean in the1960s, itfailedto adoptpoliciesthat could helpimmigrant’saccesseducation.Accordingto Solomon & Mishra (2014) ideological swings(includingtheneedto supporttheglobal economyandstandardizationof curriculum) that characterizeprovincialgovernmentshavesupportedthedominantsocietywhileputtingtheminoritygroups(includingAfro-Caribbean) at a disadvantage.However,recentstudiesattributeunderachievement of Afro-Caribbean youthsto dysfunctional families,deprivedculture,andbehaviorpatterns(Solomon & Mishra, 2014). Afro-Caribbean youthswith loweducationalachievementcannot getwell-payingjobsandthissubjectsthem to theriskof engagingin irresponsiblesexualbehaviorsthatin turnincreasetheriskof HIV infection.
ThelowincomethattheAfro-Caribbean youthsearn with equivalenteducationallevel andexperiencethewhite Canadians increasetheir riskof engagingin irresponsiblesexualbehaviors.Studieshaveshownthattheuniversitygraduatesof Afro-Caribbean background,bornin Canada, andaged25 yearsandabove andearnan averageemploymentincomeof about$ 29,700 comparedto thewhite Canadians whoearn$ 37,200 annually(PHAC, 2014).In addition,theforeign-bornAfro-Caribbean are theworstaffectedbecausetheyan averageof $ 28,700 comparedto non-Afro-Caribbean immigrantswhoarebornin foreigncountries(PHAC, 2014). Thewagegapat thegraduatelevel whereequityis expectedto beobservedshowsthattheAfro-Caribbean youthsare paidfarlesswhentheyacquirejobswithout highereducationcertificates.Mostimportantly, wagestandardizationhas beendecreasingat therateof 5 %, which meansthattheAfro-Caribbean will continueearninglessthan whattheir white Canadians earnannually.
Theexistenceof therelationshipbetween lowincomeandtheprevalenceof HIV / AIDs is a controversialissue.However,studieshaveshownthatearningan incomethat is lowerthan thesubsistencelevel increasethechancesfortheaffectedpeopleengagingin high-riskbehaviors(Parkhurst, 2009). Lowincomeiscloselyassociatedwith theweakendowmentof financial,humanresources,lowlevels of literacy,lowlaborproductivity,poorhealthstatus,andmarketableskills.Circumstancesof socialexclusionincreasethechallengesof reachingtheaffectedgroupsthrough that areaimedat reformingtheir sexualbehavior.Therefore,lowincomeis one of thekeydeterminants of HIV prevalenceamong theAfro-Caribbean youths.
Socialsupportnetworksare criticaltoolsthat are usedto increasethecapacityof thestressed orsickpeopleto dealwith their healthconditions.Thesenetworksare madeup of peers,familymembers,andfriends(CIHR, 2015). However,socialsupportnetworkscan be establishedby healthypeoplesince theygivemembersthecomfortof understandingthatpeoplearound them careforthem. Socialsupportnetworkenhancesthewellbeingof thesocietyby improvingthesenseof belonging,a feelingof security,andsenseof self-worth. In thecaseof Afro-Caribbean youths,thelackof sufficientknowledgeabout andthenumberof socialsupportnetworkshas contributedtowards theincreasesinprevalenceof HIV. Astudyconductedto assesstheavailability of thesocialsupportnetworksandhealthcareservicesto womensufferingfrom HIV in Ontario revealedthattheavailablenetworksandhealthcareservicesweredesignedto addresson theneedsofthemainstream groups(CIHR, 2015).Thepolicymakersandthestakeholders in thehealthcaresectorfailedto recognizethattheAfro-Caribbean youthsagedbetween 18 and29 yearsare alsoat a highriskof contractingHIV.
Currently,there are veryfewnon-governmental andgovernmentagenciesthat providesupportto Afro-Caribbean. To thisend,thefewpeoplewhohavesomeinformationabout HIV andthesignificanceof networking learnediton their own(CIHR, 2015). Therefore,thelackof socialsupportnetworkandcommitmentof healthagenciesin Ontario will continuesubjectingtheAfro-Caribbean youthsto theriskof contractingHIV / AIDs.
Manifestationsthat characterizetheprevalenceof HIV / Aids
Theimpactsof thehighprevalenceof HIV / AIDs among theAfro-Caribbean youthsmanifestsin three majorways.First,theHIV-related deathsare moreamong theAfro-Caribbean is thehighestcomparedto otherraceslivingin Ontario. However,femaleresidents areaffectedmorecomparedto malecounterpartsubjects.Accordingto CIHR (2015) theHIV-related deathsof theAfro-Caribbean womenaccountforabout32 % of alldeathsthat resultfrom HIV / AIDs in Ontario. Thesameresearchindicatedthat,on average,theHIV-related deathsof Afro-Caribbean accountforapproximately20 % of alldeathsthat are causedby HIV / Aids in Ontario annually.Thehighdeathratecan be attributedto thetendencyof Afro-Caribbean to concealinformationabuttheir HIV infection,which deniesthem theopportunityto seekforhealthbefore theinfectionprogressesto AIDs.
Secondly,thehighprevalenceof HIV infectionamong Afro-Caribbean communitymanifestthrough theincreasesin casesof substanceabuse.Thenewsabout theHIV infectionis, in mostcases,associatedwith stress,which in turnincreasestheriskof engagingin substanceabuse.In addition,HIV infectionis associatedwith personalturmoil,socialisolation,depression,andfatalismthat increasethesusceptibilityof theHIV patientsto theriskof substanceabuse(Bi, 2006). Afro-Caribbean whonoticethattheyare sufferingfrom HIV abusedrugsas an excuseto relievestress.
Third,theeffectofhighprevalenceof HIV infectionamong Afro-Caribbean manifests through theincreasesin casesof mentalillnessamong thispopulation.Afro-Caribbean youthssufferingfrom HIV / AIDs are at a higherriskof contractingmentalillnessescomparedto thegeneralpopulation.Thisiscommonamong theyouthswhorefuseto accepttheir healthconditionanddecideto livein denial.Theseyouthsendup sufferingfrom excess stressanddepressionthat culminatesin seriousmentalillnesses.Thisgivesa betterexplanationof thehighproportion(57 %) of Afro-Caribbean sufferingfrom traumatic stressdisorder(Haines, DeVellis, Keyserling, Siscovick, 2000).
Afro-Caribbeanaged 18-29 youths are at a higher risk of HIV infection compared toyouths from other racial groups living in Ontario. Afro-Caribbeangays are at a higher risk than non-gays youths. The risky behaviors(such as unprotected behaviors, prostitution, and same-sex practices)have increased the risk of infection among the youths in thisaggregate (CACVO, 2013).
Thiscommunity diagnosis focuses on Afro-Caribbean aged 18-29 youthsliving in Ontario. Afro-Caribbean youth, who form the aggregate forthis community diagnosis, include the first generation Afro-Caribbeanand recent immigrants. Currently, Afro-Caribbean are classified asthe third largest minority group, but ranked as the first among thatgroup that are at the risk of HIV infection, in addition to otherdiseases (PHAC, 2015). Therefore, this community diagnosis focuses onthe risk of HIV infection among the Afro-Caribbean aged 18-29 youthsliving in Ontario.
Thelow educational attainment among is positively associated with therisk of HIV infection. This is because the Afro-Caribbean youths withlow educational attainment cannot get well-paying jobs or engage inactivities that can help them earn at least subsistence income(Solomon & Mishra, 2014). Therefore, inequality in the educationsector in Ontario has disfavored the Afro-Caribbean youths, which hasincreased the risk of their engagement in risky behaviors. Inaddition, the fact that Afro-Caribbean earns less than the whiteCanadians makes the aboriginals feel discriminated against. Moreover,most of them are paid salaries that cannot sustain them, whichincreases the risk of unhealthy behaviors and HIV infection. Inaddition, the lack of social support networks that can address thehealth needs of Afro-Caribbean have contributed towards the high rateof HIV infection among the aggregate. Consequently, theAfro-Caribbean youths have limited knowledge about HIV (including itsmode of transmission), which increases the risk of infection.
The poor health among theAfro-Caribbean youths is manifested by the increase in the rate ofunsafe behavior. This is confirmed by the high number of HIV-relateddeaths among the Afro-Caribbean youths (Haines, DeVellis, Keyserling,Siscovick, 2000). Moreover, the psychological distress that theinfected Afro-Caribbean youths undergo increases their risk ofabusing drugs.
Afro-Caribbeanaged18-29 yearslivea developedcountry,butthelackof theopportunityto acquireattainshighereducation,equalearningcapacity,socialsupportnetworksare criticaldeterminants of healththat havesubjectedthem to theriskof HIV infection.ThepresentcommunitydiagnosisindicatesthatAfro-Caribbean youthsare at thehighestriskof sufferingfrom HIV infectionthan anyothergroupin Ontario. AlthoughOntario communityblamestheAfro-Caribbean youthsforengagingin substanceabuseandriskysexualbehaviors,itis evidentthattheyouthsgetinto theseirresponsiblebehaviorsafter learningthattheyare sufferingfrom theHIV infectionandtheyhavenooneto supportthem.Tothisend,properinformationabout HIV, establishmentof socialsupportgroups,reductionin theincoming inequalities,andprovisionof an equalopportunityto attainhighereducationis someof thethingsthat Afro-Caribbean aged18-29 yearsseesas beingsignificant.
Baidoobonso,S. (2013). Anexploration of the relationship between markers of social status andposition and HIV risk behavior in Africa, Caribbean, and other blackpopulations.Ontario: The University of Western Ontario.
Bi,G. (2006). Ontariogay men’s HIV prevention strategy.Ontario: Ontario Ministry of Health.
CACVO(2013). OntarioHIV / AIDs strategy for African, Caribbean and black communities2013-2018.Ontario: CACVO.
Haines,A., DeVellis, P., Keyserling, D., Siscovick, R. (2000). Abrief dietary assessment to guide cholesterol reduction in low-incomeindividuals: Design and validation.Washington, DC: Homeless Resource Center.
Parkhurst,O. (2009). Understanding the correlations between wealth, poverty andhuman immunodeficiency virus infection in African countries. WHO.Retrieved April 8, 2015, fromhttp://www.who.int/bulletin/volumes/88/7/09-070185/en/
PublicHealth Agency of Canada (2014). Population specific HIV / AIDs statusreport: People from countries where HIV is endemic, black people ofAfrican and Caribbean descent living in Canada. PublicHealth Agency of Canada.Retrieved April 8, 2015, fromhttp://www.phac-aspc.gc.ca/aids-sida/publication/ps-pd/africacaribbe/ch2-eng.php
PublicHealth Agency of Canada (2015). Population health promotion: Anintegrated model of population health and health promotion. PublicHealth Agency of Canada.Retrieved April 8, 2015, fromhttp://www.phac-aspc.gc.ca/ph-sp/php-psp/php3-eng.php
Shrestha,S. (2014). Introduction to community diagnosis. CommunityMedicine.Retrieved April 8, 2015, fromhttp://community.medchrome.com/2010/09/introduction-to-community-diagnosis.html
Solomon,R. & Mishra, A. (2014). The subversion of Antiracism: Missededucation of African Caribbean students in Britain, the USA, andCanada. CaribbeanJournal of Education,25 (1), 1-23.
TheCanadian Institute of Health Research (2015). Government of Canadaand partners support new research on HIV and AIDs. TheCanadian Institute of Health Research.Retrieved April 8, 2015, fromhttp://www.prnewswire.com/news-releases/government-of-canada-and-partners-support-new-research-on-hiv-and-aids-284332381.html