Cultural Competence: HIV/AIDS Care, Prevention, & Treatment

Cultural Competence: HIV/AIDS Care, Prevention, & Treatment

Cultural Competence: HIV/AIDS Care, Prevention, & Treatment Presented by: Kiara Dale-Adenola, MPH Minority HIV/AIDS Coordinator Florida Department of Health in Leon County Learning Objectives

Understand the cultural aspects of HIV/AIDS particularly with race and gender Learn HIV/AIDS statistics at the national, state, and local level Identify effective programs that address HIV/AIDS in communities Implement recommendations for public health professionals and health care professional

What comes to mind when we think of Cultural Competency? Cultural Competency Cultural Inclusion

Cultural Diversity Diversity Cultural Awareness

Cultural Sensitivity Source: AIDS Education & Training Center Cultural Competency Cultural competence is the ability to interact effectively with people

of various racial, ethnic, socioeconomic, religious and social groups. The word culture is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group. The word competence is used because it implies having the capacity to function effectively. Source: Centers for Disease Control and Prevention

Source: National Center for Cultural Competence Access Your Competence: Organizational Level At a systems, organizational or program level, cultural competence requires a comprehensive and coordinated plan that includes interventions on levels of:

policy making; infra-structure building; program administration and evaluation; the delivery of services and enabling supports; and the individual. Source: National Center for Cultural Competence

Access Your Competence: Individual Level At the individual level, this means an examination of ones own attitude and values, and the acquisition of the values, knowledge, skills and attributes that will

allow an individual to work appropriately in cross cultural situations. Source: National Center for Cultural Competence Access Your Competence Cultural competence mandates that organizations, programs and individuals must have the ability to:

value diversity and similarities among all peoples; understand and effectively respond to cultural differences; engage in cultural self-assessment at the individual and organizational levels; make adaptations to the delivery of services and enabling supports; and institutionalize cultural knowledge. Source: National Center for Cultural Competence What comes to mind when you think of Cultural Humility?

Source: Asian/Pacific Islander Domestic Violence Resource Project Cultural Humility Levi (2009) states that cultural humility goes beyond the concept of cultural competence[and] that it is impossible to be adequately knowledgeable about cultures that are not your own. There is not an end point or goal to be reached when looking through

the lens of cultural humility. Learning of different races and ethnic groups, by way of a cultural humility framework, becomes a life-long endeavor for us all to strive towards. Cultural Competence vs. Culture Humility Examples:

Cultural Competence says, Im the expert. Cultural Competence is an end product. Cultural Competence implies an objective set of best practices.

Source: Bilbrey, 2014 Examples: Cultural Humility says, Youre the expert. Cultural Humility is a lifelong

process Cultural Humility implies a subjective set of best practices Elements of Culture What skills do

we need in cultural competence? Social skills Emotional skills Cognitive skills

HIV/AIDS How to Apply Cultural Competence in Prevention, Care & Treatment What is HIV & AIDS? HIV stands for human immunodeficiency virus.

AIDS stands acquired immune deficiency syndrome. It is a virus that attacks the immune system, our bodys natural defense against illness.

AIDS describes a set of symptoms and illnesses that happen at the final stage of HIV infection, if left untreated. NOTE: HIV and AIDS are different. HIV is the virus and AIDS is a syndrome. People living HIV do not always develop AIDS. Source: Planned Parenthood

Source: AIDSInfo.gov How Do You Get HIV? HIV is carried via: Semen (pre-seminal and seminal fluids) Vaginal fluids

Anal mucus Blood Breast milk Source: AVERT.org How is HIV Not Transmitted?

Source: AVERT.org Signs and Symptoms of HIV Source: Mayo Clinic

To Prevent the Spread of HIV: Get tested for HIV & STIs every 3-6 months Use a new condom every time you have sex Consider taking PrEP (pre-exposure prophylaxis) Tell your sexual partners if you have HIV If you have HIV, get into care & stay in care Use a clean needle If you are pregnant, talk to your provider about

prevention or treatment options Source: Centers for Disease Control and Prevention Factors that Influence: Bar Before the Bars This is the HIV Care Continuum we want to see, however, there are several different factors that influence the outcome of this

Source: HIV.gov Factors that Influence: Bar Before the Bars Source: National Alliance of State and Territorial AIDS Directors Source: Florida Department of Health

Source: Florida Department of Health Source: Florida Department of Health Source: Centers for Disease Control and Prevention Source: Centers for Disease Control and Prevention

Source: Centers for Disease Control and Prevention Source: Centers for Disease Control and Prevention Source: Centers for Disease Control and Prevention Source: Centers for Disease Control and Prevention

Persons Living with an HIV Diagnosis in Florida, 2017 Source: Florida Department of Health Persons Living with an HIV Diagnosis in Florida, 2017 Source: Florida Department of Health

Persons Living with an HIV Diagnosis in Florida, 2017 Source: Florida Department of Health

Source: Florida Department of Health Source: Florida Department of Health How Does Cultural Competence Apply to HIV/AIDS? The Institute of Medicine (2002) report states that "racial and

ethnic minorities tend to receive a lower quality of health care than non-minorities, even when access-related factors, such as patients' insurance status and income, are taken into account. How Does Cultural Competence

Apply to HIV/AIDS? (contd) For HIV/AIDS prevention and treatment to succeed, the special needs and life contexts of those who are marginalized because of race, ethnicity, socioeconomic status (SES), sexual orientation, age, or gender must be sensitively addressed. Cultural competence must be demonstrated not only by intervention programs and staff, but also by surveillance staff, researchers (and their investigations), as well as by those delivering prevention

services, care, and treatment programs to those who are living with HIV. Source: Institute of Medicine How Does Cultural Competence Apply to HIV/AIDS? (contd) For many racial and ethnic minorities, preferences for treatment are often difficult to separate from mistrust of health professions that

stems from racial discrimination and the history of segregated and inferior care for minorities For many African Americans, doubts about the trustworthiness of physicians and healthcare institutions spring from collective memory of the Tuskegee experiments and other abuses of black patients by largely white health professionals Source: Brandt, 2012

How Does Cultural Competence Apply to HIV/AIDS? (contd) It is reasonable to assume that experiences of real or perceived discrimination in healthcare settings can affect patients' feelings about their clinical relationships and thereby dampen their interest in vigorous diagnostic and therapeutic measures. A study found that African-American patients with African-American healthcare providers were more likely than those with non-minority

providers to rate their physicians as excellent in providing healthcare, in treating them with respect, in explaining their medical problems, in listening to their concerns, and in being accessible Source: Saha, Komaromy, Koepsell, and Bindman, 1999 Source: Purnell, 2018 Culturally Competent

Care While providing culturally competent care, it is important to know: The impact of secrecy, shame, stigma, and guilt on a patients physical, spiritual, and mental health How country of origin, cultural nuances, and social networks can impact a client How to conduct a holistic assessmenttaking a picture of behaviors, social networks, country of origin, support networks,

etc. How to create an environment welcoming of people of color. Source: AIDS Education & Training Center Effective Programs: National Level

Source: Centers for Disease Control & Prevention Effective Programs: State Level Source: Florida Department of Health Effective

Programs: Local Level Source: Florida Department of Health Recommendations Achieving effective encounters with patients from ethnically and culturally diverse backgrounds is a core component of cultural competence in the clinical setting.

Encounters are necessary face-to-face interactions that allow health care professionals to effectively engage in cross-cultural interactions with culturally diverse populations. Many encounters with specific ethnic groups are needed to effectively interact with those groups. Factors such as language, cultural norms, and concepts of personal space are important variables to consider when encountering minority populations. Source: Campinha-Bacote 1998

Recommendations (contd) Cross-cultural education for health professionals Cross-cultural education offers promise as a tool to improve health care professionals' ability to provide quality care to diverse patient populations and thereby reducing health care disparities Fully integrate cross-cultural curricula into undergraduate, graduate, and continuing education of health professionals.

Using health professions grants to encourage inclusion of cultural competency materials Assess organizational and practitioner cultural competence Source: U.S. Department of Health & Human Services Recommendations (contd) Address overt and covert barriers to care

Assess your/your organizations level of awareness and sensitivity toward minority individuals living with HIV/AIDS. Conduct a cultural assessment and obtain knowledge about cultural group Source: National Minority AIDS Education and Training Center Recommendations (contd)

Maintain effective clinical encounters Check your individual/organizational biases Continue to practice & apply cultural competence and cultural humility Source: National Minority AIDS Education and Training Center References

Asian/Pacific Islander Domestic Violence Resource Project. (n.d.). Retrieved from https://www.facebook.com/APIDVRP/photos/to-practice-cultural-humility-is-to-a lways-be-willing-to-suspend-what-you-know-a/10155494619361780/ BESAFE: A Cultural Competency Model for African Americans. (2005). Retrieved from https://www.targethiv.org/library/besafe-cultural-competency-modelafrican-americans Bilbrey, J. (2014). Cultural Competency Vs. Cultural Humility. Retrieved from https://www.patheos.com/blogs/loveisanorientation/2014/08/culturalcompeten cy_v_culturalhumility/

Brandt, B. F. (2012). Effective Teaching and Learning Strategies. Retrieved from https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1592/phco.20.16.307S.3 5004 Butler, M. (n.d.). Racial/Ethnic Populations. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK361128/ References Cultural Competence | National Prevention Information Network. (n.d.).

Retrieved from https://npin.cdc.gov/pages/cultural-competence#7 Cultural Humility vs. Cultural Competence. (2013). Retrieved from https://soundscapingsource.com/cultural-humility-vs-cultural-competence/ Curricula Enhancement Module Series. (n.d.). Retrieved from https://nccc.georgetown.edu/curricula/culturalcompetence.html HIV. (2015). Retrieved from https://www.cdc.gov/hiv/policies/nhas.html HIV Care Continuum. (2018). Retrieved from https://www.hiv.gov/federalresponse/policies-issues/hiv-aids-care-continuum

References HIV Prevention & Health Equity. (n.d.). Retrieved from https://www.nastad.org/domestic/hiv-prevention-health-equity HIV/AIDS. (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-203 73524 HIV/AIDS: The Basics Understanding HIV/AIDS. (2019). Retrieved from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/19/45/hiv-aids--the-basi

cs HHS Office & Assistant Secretary for Health. (2014). LGBT Competency Training. Retrieved from https://www.hhs.gov/programs/topic-sites/lgbt/enhanced-resources/competency-tr aining/index.html Levi, A. (2009). The Ethics of Nursing Student International Clinical Experiences. Journal of Obstetric, Gynecologic & Neonatal Nursing, 38(1), 9499. doi: 10.1111/j.1552-6909.2008.00314.x

References Myths about HIV and AIDS. (2019, August 13). Retrieved from https://www.avert.org/hiv-transmission-prevention/myths Parenthood, P. (n.d.). What Is HIV / AIDS & How Do You Get It? Retrieved from https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids Purnell, L. (2018). Education and Training in Culturally Competent Care. Global Applications of Culturally Competent Health Care: Guidelines for Practice, 6175. doi: 10.1007/978-3-31969332-3_6 Randall, P. (1996). Adult bullying: perpetrators and victims. London: Routledge.

Saha, S., Komaromy, M., Koepsell, T. D., & Bindman, A. B. (1999). Patient-Physician Racial Concordance and the Perceived Quality and Use of Health Care. Archives of Internal Medicine, 159(9), 997. doi: 10.1001/archinte.159.9.997 Unequal treatment: confronting racial and ethnic disparities in health care. (2003). Choice Reviews Online, 40(10). doi: 10.5860/choice.40-5843

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