Read the case study provided and answer the three part discussion. Each section sould be 250-300 words. APA citaions.Step 1: Analyze the Ethical Dimensions of the Public Health Issue and ContextThere are two public health professionals involved in decision-making in this scenario. Dr. Albert is a social scientist with strong training in conducting research. Dr. Baines is a community worker who focuses on interventions with the community. Dr. A wants to use this opportunity as a research study that could generate new information that could be generalized to other communities. Dr. B wants to focus their efforts on intervening in their own community rather than spending time on conduction research.This intervention would focus on a small subset of their community population, black men who have sex with men. Conducting research would allow them to generalize their findings to a broader population, but would also mean that the subjects in the control group don’t get the intervention. Conducting this education as an intervention would mean focusing on all black men who have sex with men within their community, but the outcomes could not be published as a research study that could benefit other communities and populations.Respond to these questions on your discussion board:As public health professionals, do Dr. Albert and Dr. Baines have ethical obligations to other populations within their community? How about outside the community? Which obligation should be their highest priority, the subset of men who have sex with men, their whole community, or populations outside their community?On what basis is the public health agency justified in advancing interventions that target only a subgroup of the community?Step 2: Formulate Alternative Courses of Action and Evaluate their Ethical DimensionsWhat is the appropriate public health goal in this situation? Providing an intervention that will improve the health of the members of their community, or doing research to create new knowledge that could impact many communities?If the educational program is used as a research study, what are the possible benefits and risks to the experimental participants? What are the possible risks and benefits to the control group?Based on your answer to the first question, is approval from an IRB necessary?Step 3: Provide Justification for a Particular Public Health DecisionShould this project go forward as a research study or as an intervention?What is the justification for your decision? (Which ethical principles take priority and why?)Case Study :9.9 Case 4: Internet-Based HIV/AIDS Education and Prevention Programs in Vulnerable Populations: Black Men Who Have Sex with Men Amar Kanekar Department of Health, Human Performance and Sport Management University of Arkansas at Little Rock Little Rock , AR , USA e-mail: axkanekar@ualr.edu This case is presented for instructional purposes only. The ideas and opinions expressed are the author ’ s own. The case is not meant to refl ect the offi cial position , views , or policies of the editors , the editors ’ host institutions , or the author ’ s host institution . 9.9.1 Background Since surfacing more than 30 years ago, the HIV/AIDS pandemic has devastated populations worldwide. Various factors have contributed to this epidemic, such as lack of awareness of HIV status, stigma, homophobia, negative perceptions about HIV testing , socioeconomic factors, behavioral risk factors, and high prevalence of sexually transmitted diseases ( Centers for Disease Control and Prevention 2015 ). In the United States, one goal of the national HIV/AIDS strategy is to re duce HIVrelated hea lth disparities. Any reduction in the collective risk of acquiring HIV will require behavior change interventions in communities with the highest HIV prevalence. However, extending the reach of HIV/ AIDS preventive interventions in remote areas with limited access to HIV testing and prev ention services has proved diffi cult (Offi ce of National AIDS Policy 2012 ). The challenge of reaching some populations has led many practitioners to consider innovative intervention methods that rely on technologies such as the Internet and mobile telephones. Public health profession als are using these technologies to deliver health education to vulnerable populations in big cities, small towns, and D.H. Barrett et al. 315 hard-to-reach rural areas. In particular, the past decade has seen more health communication efforts using the Internet to prevent HIV and sexually transmitted diseases (Bull et al. 2007 , 2009 ; Rietmeijer and McFarlane 2009 ). Studies of interventions that use Internet chat rooms, online modules, and health intervention websites show promising results that bode well for the future of these technolo gies (Chiasson et al. 2009 ; Moskowitz et al. 2009 ). Studies conducted with marginalized and vulnerable populations such as black men who have sex with men (MSM) can pose diffi culties. On the technology front, many diffi culties refl ect the Internet’s relative novelty for conducting studies and the consequent lack of clarity in dealing with the rules, language, and norms of a virtual community culture compared with a traditional community culture (Loue and Pike 2010 ). On the allocation front, having limited resources usually implies that tailoring interventions to a specifi c group will mean forgoing benefi ts to another group. Still, in promoting the health of populations, public health professionals must strive to distribute resources fairly while responding to the specifi c needs of racial, ethnic, and cultural groups. These concurrent goals require maintaining a delicate balance between targeted and population interventions. On the ethics front, because some projects straddle the line between research and practice, public health profession als can become unsure about whether the ethical guideline s of research or of community work should govern their actions. They must bear in mind that trust , which is essential for conducting community-based participatory research , becomes more crucial when working with vulnerable populations, which tend to show a high degree of mistrust (Loue and Pike 2010 ). Those who study vulnerable populations need to negotiate community entry either by developing trust or by working closely with local practitioners and building upon established trust. In the United States , the HIV/ AIDS epidemic has hit the African-American population hardest, with black men accounting for 70 % of new HIV infections . Between 2006 and 2009, new HIV infections increased 48 % among black 13- to 24-year-old MSM (Centers for Disease Control and Prevention 2015 ); by 2009, 37 % of new HIV cases among black men were from black MSM. Given this high prevalence, before the end of 2015, the U.S. national HIV/AIDS strategy calls for a 20 % increase in the proportion of African Americans diagnosed with HIV who have an undetectable viral load (Offi ce of National AIDS Policy 2012 ). Already, information about HIV issues affecting young MSM (Mustanski et al. 2011 ) is widely available on the Internet, including messages about how to reduce risk (Hightow-Weidman et al. 2011 ) and interventions to prevent HIV risk behaviors among MSM (Rhodes et al. 2010 ) and blacks who inject drugs (Washington and Thomas 2010 ). Studies show that online delivery of HIV counseling and behavioral interventions for MSM at high risk for HIV are successful, suggesting that the future holds great promise for Internet-delivered interventions for this vulnerable population (Chiasson et al. 2009 ; Moskowitz et al. 2009 ). 9 Public Health Research 316 9.9.2 Case Description Dr. Albert, a social scientist, and Dr. Baines, a community worker, are employed by a public health agency in a medium-size U.S. town. The agency has asked them to determine whether a skill-based, Internet-delivered intervention to promote safer sex among young Black MSM will increase HIV knowledge and increase the frequency of using safer-sex practices. Project participants will be recruited via the Internet in gay chat rooms and be verifi ed electronically by using Internet Protocol and Microsoft Access usernames and passwords (Bull 2011 ). Participants will be surveyed before they begin the training modules and again at 1- and 6-week intervals after completing the modules. Participants will be randomly assigned to control and experimental arms. Those in the control arm will receive 6 h of online training about health and well-being (e.g., nutrition, physical activity, stress reduction). The experimental arm will receive a 6-h online program including two 1-h modules on each of the following topics: (a) HIV/AIDS-related knowledge; (b) development and improvement of safe sex skills, such as partner communication and monogamous sexual relationships; and (c) selfeffi cacy in using condoms. The modules will include automated reminders for HIV testing . The study will measure improved knowledge on HIV/AIDS , partner communication about safer sex, and condom usage self-effi cacy. Data will be analyzed using statistical software. Dr. Albert thinks the results could be generalized not only to black MSM in the community but also to black MSM overall. He plans to write an article describing the results for publication in a scientifi c journal. Although Dr. Baines knows the impact of education on health, especially in underprivileged communities, she wants to educate only a subset of the community they will reach. Besides, since their work is for a public health agency, she believes the intervention ought to reach as many community members possible. She claims the project’s goal is to provide a vulnerable and disadvantaged population with much needed education on health matters and health-promoting behavior and doubts their project constitutes research. Dr. Albert worries that, because his colleague lacks academic rigor and underappreciates the role of evidence, she fails to appreciate the project’s rationale and design and, as a result, is indifferent to the challenges the Internet poses (e.g., technology- induced bias, protection of confi dentiality). Conversely, Dr. Baines believes Dr. Albert has missed the boat and is wasting resources, spuriously introducing statistical analysis of experimental and control arms into what the agency clearly had intended as an education intervention. Open Access This chapter is distributed under the terms of the Creative Commons AttributionNoncommercial 2.5 License (http://creativecommons.org/licenses/by-nc/2.5/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. 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