Presenters: John Nelson, PhD, CPNP Donna Sweet, MD Anna Kinder, MS, OTR/L

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1 Presenters: John Nelson, PhD, CPNP Donna Sweet, MD Anna Kinder, MS, OTR/L

2 Recognize the differences in HIV Care Continuum outcomes for persons living with HIV (PLWH) in rural and non-rural jurisdictions of the United States and its territories (U.S.). Identify types of stigma experienced by PLWH in rural jurisdictions of the U.S. Discuss ways to decrease organizational stigma for PLWH accessing healthcare in rural jurisdictions of the U.S.

3 Rural describes any territory populated with <50,000 people and not part of an urban cluster (10,000-49,999 people with density of 1,000 people per square mile (ppsm) or 500 ppsm and specified resource availability. Ratcliffe M, Burd C, Holder K, Fields A, U.S. Census Bureau. Defining Rural at the U.S. Census Bureau - American Community Survey and Geography Brief. December Accessed 1/11/17

4 Ratcliffe M, Burd C, Holder K, Fields A, US Census Bureau. Defining Rural at the U.S. Census Bureau - American Community Survey and Geography Brief. December Accessed 1/11/17

5 Ratcliffe M, Burd C, Holder K, Fields A, US Census Bureau. Defining Rural at the U.S. Census Bureau - American Community Survey and Geography Brief. December Accessed 1/11/17

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7

8 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

9 Percentage, % Figure 2. Retention in HIV medical care and viral suppression, among people aged 13 years with HIV infection diagnosed by year-end 2011 and alive at year-end 2012, by population category of residence at diagnosis 28 United States jurisdictions (n= 530,2 Metropolitan Urban Rural * 50.0* * 46.2* Retention in care Viral suppression Population Category *Statistically significant compared with Metropolitan (Prevalence Ratio < 1 and outside of Confidence Interval). Retention in care was defined as 2 CD4 or VL tests performed 3 months apart during Viral suppression was defined as a viral load result of <200 copies/ml.

10 Rural residents less likely to get HIV tested Rural residents more likely to internalize HIV-related stigma (S. Kalichman, H. Katner, E. Banas, & M. Kalichman; 2016) Rural residents are more likely to be tested in non-rural places (S. Kalichman, H. Katner, E. Banas, & M. Kalichman; 2016) Rural residents more likely to be diagnosed with AIDS at the time of initial HIV diagnosis Rural residents are less likely to be retained in care (CDC, Rural Health Committee; 2016) Rural residents are less likely to be virally suppressed (CDC, Rural Health Committee; 2016)

11 Stigma refers to the disgracing or shaming of people themselves (internalized), by others, and by organizations/institutions (primarily through policies, laws, and behaviors of those within the organization/institution) due to perceived socially unacceptable attributes. 1,2 1. Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS (London, England). 2008;22(Suppl 2):S67-S79. doi: /01.aids NAM aidsmap. NAM Publications,

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13 aidsetc.org

14 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

15 Project ECHO model (developed by University of New Mexico) now used by Mountain West AETC to provide regular communities of learning among rural primary care providers to provide education, problem solving, and case study discussions related to providing HIV care University of Kansas School of Medicine Wichita: takes HIV care team to three different rural sections of Kansas once/6 weeks to provide care

16 Use of mobile health van Use of consultants, including National Clinician Consultation Center Use of Community Health Workers, Linkage Coordinators, Navigators Other examples???

17 Decriminalize HIV Reduce community, healthcare provider, and internalized HIV-related stigma Reduce other barriers to accessing quality, confidential care in rural U.S. Increase education of ALL healthcare providers and health profession students to provide HIV related prevention, testing, diagnosis, and treatment in rural communities

18 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

19 Theresa Bramel (AK) Joseph Cantil (AK) Laurie Dill (AL) Alyssa Guido (AZ) Jennifer Janelle (FL) Harold Katner (GA) Donna Sweet (KS) Liz Lazo (NJ) John Nelson (NJ) Tracy E Jungwirth (NM) Dayna Morrison (OR) Jason Henry (VIs) Natalia Martinez-Paz (WA) Jeannette Southerly (WV) Anna Kinder (WY)

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