HIV/AIDS AND CULTURAL COMPETENCY

HIV/AIDS AND CULTURAL COMPETENCY

Learning Objectives Gain a Basic Understanding of Cultural Competency Discuss the Importance of Cultural Competency in Addressing Health Disparities Review the Relationship between Cultural Competency and Quality of Care

Cultural Competency

Why is Culture Important? It affects. Parenting and child rearing Communication Body language Perception of time Help-seeking behaviors; help-giving behaviors Stigma Attitudes and beliefs about law, social support, health, family support, and what constitutes successful services Use of services and social supports Understanding of government systems Perception of the world Source: Lazear K., 2003

Cultural Competence - Definition Cultural and linguistic competence are a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals which enables effective work in cross-cultural, or bilingual situations. Source: HRSA, Office of Minority Health

Cultural Competency A set of behaviors and attitudes that providers use to: Understand their own values and culture Value diversity and cultural difference in their patients Adapt to the culture of the family or community they are serving Work effectively in cross-cultural situations

Cultural Competency Culture: Learned behavior, beliefs and attitudes, with emphasis on the word learned. It s important to understand that we all have culture, and it s not limited to ethnicity.recognize that as physicians, physician s assistants, nurse practitioners, nurses and social workers, we have a healthcare culture that we learned that also affects the interaction with patients. Understanding we re all different - not that we re all the same - is where the learning starts. We cannot expect to have a cultural pocket-guide for populations; the generalities would only be starting points. Source: AETC, Samantha Euraque on Cultural Awareness Trainings for HIV Healthcare Providers

Cultural Competency How can health care providers fully comprehend culture, much less become competent? It is a huge and moving target! Individuals have culture constellations: Race, ethnic background, religion, a profession, gender, sexual orientation, income level/socioeconomic status, age All of these are associated with cultures and they are just a few. Culture isn t static. Over time individuals accept, reject, adopt, and modify their cultures. Source: Lucy Bradley-Springer, AETC, Teaching Cultural Competency - What Are the Key Points?

True cultural competence includes Linguistic Competency and Health Literacy.

Linguistic Competence - Definition The capacity of an organization and its personnel to communicate effectively, and convey information in a manner which is easily understood by diverse audiences: Persons of Limited English Proficiency (LEP) Individuals who have low literacy skills or are not literate Individuals with disabilities Persons who are deaf or hard of hearing Linguistic competency requires the capacity to respond effectively to health literacy needs. Organizations must have policies, structures, practices, procedures, and dedicated resources to support this capacity. Source: Goulda Downer AETC, 2012

Health Literacy Definition The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Source: The Institute of Medicine, 2004

Health Literacy Health literacy refers to an individual s ability to use text, numbers, and general information to navigate the everyday world and manage his or her health. This involves not only understanding how to follow the directions on a bottle of medication but also reading signs, maps, and transportation schedules to find a clinic. Source: HRSA CARE Action 2013

Cultural competency is viewed as a continuum rather than as a one-time goal. It involves a provider creating a setting that puts clients at ease and encourages them to remain engaged in care. Source: HRSA CARE Action 2013

Cultural Competency Continuum

Health Disparities

Racial and ethnic minorities have been disproportionately affected by HIV/AIDS and represent the majority of new HIV infections, people living with HIV disease, and deaths among people with HIV. Source: Kaiser Family Foundation, The HIV/AIDS Epidemic in the United States, 2014

Health Disparities The U.S. is a linguistically and culturally diverse country that is becoming even more diverse with time. African-Americans are most affected by HIV/AIDS, followed by Hispanics/Latinos, Asians, Native Hawaiian/Pacific Islanders, and American Indian/Alaska Natives. HIV has also had a particularly devastating impact on subpopulations that cut across these groups, including MSM, substance users - most particularly injection drug users (IDUs) - currently and formerly incarcerated persons, and transgender women. Source: HRSA CARE Action 2013

Diagnoses of HIV Infection and Population by Race/Ethnicity, 2014 United States Diagnoses of HIV infection N=44,0073 Population, United States N= 318,857,056 2% 27% 23% < 1% 1% 2% 44% American Indian/Alaska Native Asian Black/African American Hispanic/Latino Native Hawaiian/other Pacific Islander White Multiple Races 62% 2% 1% 5% 12% 17% < 1% American Indian/Alaska Native Asian Black/African American Hispanic/Latino Native Hawaiian/other Pacific Islander White Multiple races Source: HIV Surveillance Epidemiology of HIV Infection (through 2014), CDC.gov

Diagnoses of HIV Infection and Population among Adult and Adolescent Females, by Race/Ethnicity 2014 United States Diagnoses of HIV Infection N=8,328 Female Population, United States N=136,147,401 American indian/alaska Native American indian/alaska Native <1% 2% 18% 1% 2% Asian Black/African American 2% 1% 6% 13% Asian Black/African American 16% 62% Hispanic/Latino Native Hawaiian/other Pacific Islander 64% 15% Hispanic/Latino Native Hawaiian/other Pacific Islander White White Multiple races <1% Multiple races Source: HIV Surveillance Epidemiology of HIV Infection (through 2014), CDC.gov

Diagnoses of HIV Infection among Adult and Adolescent Blacks/African Americans, by Sex and Transmission Category 2014 United States and 6 Dependent Areas Males N=14,319 Females N=5,131 5% 2% < 1% 15% Male-to-male sexual contact Injection drug use (IDU) < 1% 9% Injection drug use (IDU) 78% Male-to-male sexual contact and IDU Heterosexual Contact 91% Heterosexual Contact Other Other Source: HIV Surveillance Epidemiology of HIV Infection (through 2014), CDC.gov

Diagnoses of HIV Infection among Adult and Adolescent Hispanics/Latinos, by Sex and Transmission Category 2014 United States and 6 Dependent Areas Males N=9379 Females N=1,490 5% 3% 8% <1% 84% Male-to-male sexual contact Injection drug use (IDU) Male-to-male sexual contact and IDU Heterosexual Contact 86% 1% 13% Injection drug use (IDU) Heterosexual Contact Other Other Source: HIV Surveillance Epidemiology of HIV Infection (through 2014), CDC.gov

Diagnoses of HIV Infection among Adult and Adolescent Hispanics/Latinos, by Sex and Place of Birth 2014 United States and 6 Dependent Areas Males N=9,379 Females N=1,490 United States United States 3% 19% 39% Centra America South America Cuba 7% 18% 34% Centra America South America Cuba 15% Mexico 15% 10% Mexico 9% 4% 5% 6% Puerto Rico Other 2% 10% 3% Puerto Rico Other Unknown Unknown Source: HIV Surveillance Epidemiology of HIV Infection (through 2014), CDC.gov

Impact of HIV/AIDS on Racial And Ethnic Minorities African Americans and Latinos account for a disproportionate share of new HIV infections, relative to their size in the U.S. population. African Americans: Total 222,185 diagnoses of HIV infection in 2010 2014 African Americans: 45% of total population African American women: 62% of women with HIV African American children: 64% of children with HIV aged <13 years In 2014, 44% of diagnoses of HIV infection among adults and adolescents were in African Americans. Source: HIV Surveillance by Race/Ethnicity (through 2014), CDC.gov

Impact of HIV/AIDS on Racial And Ethnic Minorities Hispanic/Latinos: Total 222,185 diagnoses of HIV infection from 2010 2014 Hispanics/Latinos: 23% of total Hispanic/Latino women: 17% of women Hispanics/Latinos : 18% of infections attributed to heterosexual contact Hispanic/Latino children: 11% of children aged <13 years In 2014, 24% of diagnoses of HIV infection among adults and adolescents were in Hispanics/Latinos. Source: HIV Surveillance by Race/Ethnicity (through 2014), CDC.gov

Impact of HIV/AIDS on Gay and Bisexual Men Of the 221,127 diagnoses of HIV Infection among adults and adolescents during 2010 through 2014: 80% were in males 80% of diagnosed HIV infections in males were attributes to male-to-male sexual contact 23% of diagnosed HIV infections in males were among those aged 13-24 years 92% of diagnosed HIV infections in males aged 13-24 years were attributes to male-to-male sexual contact In 2014, 63% of HIV infections diagnosed among adults and adolescents were attributed to male-to-male sexual contact Source: HIV Surveillance Men Who Have Sex with Men (MSM) (through 2014), CDC.gov

Health Disparities in Treatment Delivery and Care Outcomes Racial and ethnic minorities tend to receive a lower quality of health care than non-minorities. Institute of Medicine 2002 HIV disparities manifest in: Retention in care Viral suppression Timing of ARV prescription Late presentation for care Source: National Quality Center, Cultural Competence as a Quality Issue: Practical Steps to Improvement

Health Disparities in Treatment Delivery and Care Outcomes The effectiveness of HIV/AIDS treatment depends largely on the ability of members and providers to communicate effectively about treatment options and protocols. Effective treatment depends upon members trust in their providers, willingness to follow recommended protocols, and ability to understand clinical recommendations. A provider s cultural competence is critical for eliciting these responses. Source: Goulda Downer AETC, 2012

Cultural Competency and HIV/AIDS

Cultural Competency and HIV/AIDS Cultural competency involves accepting a patient as a person no matter what regardless of their race, ethnicity, or sexual identity (Dr. Lawrence Friedman, University of Miami, Miller School of Medicine). The need for this acceptance and cultural capacity in HIV cannot be overstated. Walk through the door of HIV/AIDS provider clinics, and you will find a cross-section of the communities hardest hit by HIV/AIDS since the epidemic began: people of color, substance users, and sexual minorities. They are living at or below the FPL, are un/underemployed, have unstable housing, little or no insurance, and limited educational attainment. Entering HIV care often marks the first time they have ever had a primary care physician. Source: Cultural Competency and HIV/AIDS Care: The Legacy of the Ryan White HIV/AIDS Program

Cultural Competency and HIV/AIDS Culturally competent care involves: a relationship between member and provider based on trust and a rapport developed over time. It does not begin with the doctor; but includes the entirety of the clinical staff, from the front door to the physician and everyone in between. Providers that create a hostile or stigmatizing environment for people living with and affected by HIV will ultimately alienate members and deter them from care. Source: Cultural Competency and HIV/AIDS Care: The Legacy of the Ryan White HIV/AIDS Program

Cultural Competency and HIV/AIDS Effectively treating members living with HIV/AIDS involves more than asking them about their symptoms and writing prescriptions. It demands an understanding of their experiences and circumstances - their lives as a whole. Sources: A Guide to Addressing Cultural Competence as a Quality Improvement Issue in HIV Care, K. Clanon, H. Issaq, N. Halloran; Health HIV Putting Health First; Source: Cultural Competency and HIV/AIDS Care: The Legacy of the Ryan White HIV/AIDS Program

Cultural Competency And Quality of Care

Cultural Competency and Quality of Care To be culturally competent doesn t mean you are an authority in the values and beliefs of every culture. What it means is that you hold a deep respect for cultural differences and are eager to learn, and are willing to accept, that there are many ways of viewing the world. Source: HRSA CARE Action 2013

Cultural Competency and Quality of Care Cultural differences between providers and members affect the provider-member relationship. How members feel about the quality of that relationship is directly linked to client satisfaction, adherence, and subsequent health outcomes. If the cultural differences between members and providers are not recognized, explored, and reflected in the medical encounter, member health outcomes may suffer. Source: HRSA CARE Action 2013

Cultural Competency and Quality of Care Providers engaged in culturally competent care tailor their services to the individual, social, cultural, and linguistic needs of their members. Cultural competence requires more than knowing a member s language or food preferences. Culturally competent HIV/AIDS care reflects an understanding of members unique worldview, particularly as it relates to their perception of health, which may be reflective of their cultural background and norms, their health literacy, and their ability to access services. Source: HRSA CARE Action 2013

Case Study Source: National Quality Center, Cultural Competence as a Quality Issue: Practical Steps to Improvement

SUMMARY

Summary Cultural diversity includes differences in how people understand and address health, illness, and health care. In the case of HIV/AIDS, these factors are related to reduction of new infections, increased access to care, improved health outcomes for people living with HIV, and reduction of HIV-related health disparities and inequities. Effective providers recognize this and learn to communicate effectively with members who have diverse backgrounds and understandings of health and health care. Culturally competent approaches include providing language interpreters, expanding clinic hours to increase access and accommodate cultural expectations for longer clinical visits and discussions, and understanding and respecting members cultural traditions regarding medicine and healing. Culturally competent care has been associated with increased trust in clinicians, increased satisfaction, and increased treatment adherence. Source: Goulda Downer AETC, 2012

Cultural Competency Skills Being aware of your own culture and values Respecting differences Being aware of, and working at, controlling your own biases and how they affect interactions with others Understanding institutional barriers that prevent access to resources Building strong cross cultural team relationships Advocating for individuals who are different from yourself Using effective communication skills across differences Mediating cross-cultural conflicts Being flexible Source: The Strength And Power of Diversity

Culturally Competent Communication Recognize differences Build Your Self-Awareness Describe and Identify, then Interpret Don t assume your interpretation is correct Verbalize your own non-verbal signs Share your experience honestly Acknowledge any discomfort, hesitation, or concern Practice politically correct communication Give your time and attention when communicating Don t evaluate or judge Be cautious about humor Source: The Strength And Power of Diversity

Progressing Toward Cultural Competence Value members cultural beliefs Exhibit genuine concern and respect Learn about the needs and challenges of a community Be willing to understand members life experiences Source: The Strength And Power of Diversity

We all should know that diversity makes for a rich tapestry, and we must understand that all the threads of the tapestry are equal in value no matter what their color. Maya Angelou