Addressing Social Determinants of Health in HIV Prevention and Care: Examples from the Field

Transcription

1 Addressing Social Determinants of Health in HIV Prevention and Care: Examples from the Field The National Capacity Building Assistance Provider Network

2 Welcome & Introductions Capacity building assistance (CBA) providers The National CBA Provider Network (CPN) Resource Center

3 2017 CDC Priorities: Reduce HIV-related Disparities and Health Inequities Source: Eugene McCray (2017). Update on HIV Incidence and Putting Prevention Advances to Work.

4 National HIV/AIDS Strategy (NHAS) for the United States: Updated to Reduce new infections. 2. Increase access to care and improve health outcomes for people living with HIV. 3. Reduce HIV-related health disparities and health inequities. 4. Achieve a more coordinated national response to the HIV epidemic. Source: Office of National AIDS Policy, National HIV/AIDS Strategy for the United States: Updated to 2020, July 2015 [Internet].

5 Meeting NHAS Goal #3 The nation cannot meet the strategy goals without reducing HIV-related disparities in communities at high risk for HIV infection. Structural approaches can reduce risk of HIV transmission at community and societal levels. Stigma and discrimination must be eliminated in order to diminish barriers to HIV prevention.

6 Creating a Common Language

7 Definition of Health A state of complete physical, mental, social, and spiritual well-being, not merely the absence of disease or infirmity Source: World Health Organization. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

8 Health Equity Is attainment of the highest level of health for all people Source: Centers for Disease Control and Prevention. Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; October 2010.

9 Health Inequity Refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice Source: Kawachi, I., Subramanian, S., & Almeida-Filho (2002). A glossary for health inequalities. Journal of Epidemiology and Community Health: 56:

10 Health Disparity A term used in epidemiology to describe differences, variations, and disproportions in the health status of individuals or groups Descriptive term No value judgment necessarily implied Source: Adapted from: Kawachi, I., Subramanian, S., & Almeida-Filho (2002). A glossary for health inequalities. Journal of Epidemiology and Community Health: 56: ; Carter-Pokras, O., & Baquet, C. (2002). What is a health disparity? Public Health Reports, 17:

11 Determinants of Health 1. Individual Behaviors 2. Biology & Genetics 3. Social 5. Health Services 4. Physical Environment Environment

12 Social Determinants of Health (SDH) Conditions in which people are born, grow, live, work, and age, including the health system. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels, which are themselves influenced by policy choices that impact quality of life, for better or worse Source: World Health Organization [Retrieved September 28, 2016]; Social Determinants of Health, 2014.

13 Video Clip: Ta-Nehisi Coates

14 Some Reasons for Current HIV-related Disparities and the list goes on

15 Determinants of Health: HIV Example

16 HIV Prevention and Care & Health Equity Stigma and other social determinants can affect an individual's progress along the HIV care continuum

17 HIV Continuum & SDH Poverty Access to healthcare Access to support Racism Access to education Linkage to HIVinclusive primary care Screen for risk factors and barriers Retention in care and services Prescribe HIV treatment Undetectable viral load HIV Positive (Continuum of Care) HIV Negative (Prevention Continuum) Linkage to primary care Screen for risk factors and barriers Retention in care and services Continued risk reduction, PrEP, PEP Remain HIVnegative Homophobia Stigma Family acceptance Transphobia Housing conditions

18 What are community-based organizations (CBOs) doing to address SDH?

19 Thrive Alabama in Albertville, AL Downtown Albertville, AL Photo credit: Rivers Langley CC BY-SA 3.0

20 How is Thrive Alabama addressing social determinants of health? Thrive Alabama, Albertville La Opinion 4/29/13

21 How the Latino Commission on AIDS partnered with Thrive Alabama to address cultural responsiveness in Albertville

22 What are healthcare organizations (HCOs) doing to address SDH?

23 Whittier Street Health Center Boston, MA

24 Whittier Street Health Center What Social Determinants of Health (SDH) are you seeing and addressing with your patient population? Low socioeconomic status Lower educational levels Employment Access to health care Unstable housing How are you addressing these SDH? Outreach Navigation Insurance Enrollment Status neutral access to HIV care

25 Whittier Street Health Center II How has CBA from PCDC helped address these SDH in your patient population? Ongoing TA/training Skills building activities Addressing SDH Team building Professional boundaries

26 Whittier Street Health Center III How has CBA from PCDC helped impact HIV service provision as it relates to the patient population and staff support? HIV testing improved Linkage to care Addressing the whole person Understanding of patient s barriers to care

27 What are health departments (HDs) doing to address SDH?

28 Background Need: Increase service provider s capacity to serve diverse clients Increase service provider s capacity to address health disparities among the LGBT community Social determinants addressed included: Structural homophobia/transphobia in health services

29 Plan Stakeholders: Health department staff Faith-based organizations Community-based organizations Action steps completed: Workshop with decision makers LGBTQ Cultural Sensitivity Workshop with providers Technical assistance to enhance the capacity of local staff to conduct the workshop

30 Outcomes Outcomes: Increased staff sensitivity to LGBTQ issues Enhanced skills to overcome potential barriers in providing culturally competent services Increased internal capacity to provide sustainable structural changes to address homophobia and transphobia Conducted 7 trainings, 92 participants (clinical staff participated) Lessons learned: Organizational and systemic change takes time. Involve and establish partnerships with local leaders and decision makers to increase buy-in and promote ownership Engage CBOs to sustain the change in the community

31 Conclusions Stigma and homophobia can be addressed to reduce barriers to access to HIV services and to achieve better health outcomes Sustainability can be achieved by involving the LBGTQ community members and creating partnerships with (diverse) stakeholders including allies from faith-based organizations

32 A Framework for Addressing SDH Blankenship, et. al, 2000

33 Strategies to Address SDH 1. Foster a supportive community. 2. Improve access to quality healthcare. 3. Transform the environmental context. 4. Collaborate across sectors and areas of health.

34 How the CBA Provider Network (CPN) Has Responded

35 Visit the CPN at:

36 CPN SDH Workgroup