Services and Outreach to the Latino Community Diana Vasquez, RN, MPA Interim Director, Care Services Office of AIDS Programs and Policy Department of Health Services March 9, 2004

2 DISEASE DATA   Latino/a AIDS Incidence (1/1/ /31/2002): 1,218 (44.1%) of 2,762 diagnoses   Latino/a AIDS Prevalence (as of 12/31/2002): 6,743 (37.5%) of 17,971 AIDS cases   Latino/a HIV (not AIDS) Prevalence (as of 12/31/2002): 11,601 (43.0%) of 26,957 of HIV

3 LATINO/A SERVICE UTILIZATION (1-12/2003) Total Unduplicated Latino Clients ,935 Of all Latino Clients Receiving Services, Proportion Receiving these Types of Services Medical Outpatient72% Case Management49% Mental Health35% Oral Health19%

4 LATINO/A SERVICE UTILIZATION (1-12/2003) MEDICAL OUTPATIENT SERVICES Represents every Service Planning Area (SPA) PROVIDER % of Latino clients in medical outpatient services at these facilities (facilities they’re using) LAC+USC Rand Schrader Clinic (5P21)25% AIDS Healthcare Foundation21% AltaMed Health Services Corporation13% LAC+USC Maternal Child Adolescent (MCA)7% Harbor/UCLA Medical Center6% Martin Luther King/Charles Drew Medical Center4% St. Mary Medical Center Care Program3% El Proyecto del Barrio1%

5 LATINO/A SERVICE UTILIZATION (1-12/2003) CASE MANAGEMENT SERVICES Represents every Service Planning Area (SPA) PROVIDER % of Latino clients in case management services at these facilities (facilities they’re using) AIDS Project Los Angeles (APLA)35% Los Angeles Family AIDS Network (LAFAN)16% AIDS Service Center (ASC)9% LAC+USC Maternal Child Adolescent (MCA)5% AltaMed Health Services Corporation4% St. Mary Medical Center Care Program3% El Proyecto del Barrio2% Bienestar Human Services2%

6 LATINO/A SERVICE UTILIZATION (1-12/2003) MENTAL HEALTH SERVICES Represents every Service Planning Area (SPA) PROVIDER % of Latino clients in mental health services at these facilities (facilities they’re using) AIDS Project Los Angeles (APLA)21% Los Angeles Family AIDS Network (LAFAN)17% LAC+USC Rand Schrader Clinic (5P21)10% AIDS Healthcare Foundation9% AltaMed Health Services Corporation8% Bienestar Human Services5% St. Mary Medical Center Care Program1% Martin Luther King/Charles Drew Medical Center1% El Proyecto del Barrio1%

7 LATINO/A SERVICE UTILIZATION (1-12/2003) ORAL HEALTH SERVICES Represents every Service Planning Area (SPA) PROVIDER % of Latino clients in oral health services at these facilities (facilities they’re using) AIDS Project Los Angeles (APLA)85% St. Mary Medical Center Care Program7% Northeast Valley Health Corporation6% LAC+USC Maternal Child Adolescent (MCA)5% H. Claude Hudson Comprehensive Health Center2% Foothill AIDS Project1%

8 CLINICAL SNAPSHOTS LAC+USC Rand Schrader Clinic (5P21) All % of total clients Unduplicated Clients2,630 Male74% Female26% New Clients21% Latino/a Clients66% No Insurance86%

9 CLINICAL SNAPSHOTS LAC+USC Maternal Child Adolescent (MCA) All % of total clients Unduplicated Clients739 Male38% Female62% New Clients27% HIV-affected38% Latino/a Clients70% Under 12 years old44%

10 CLINICAL SNAPSHOTS El Proyecto del Barrio All % of total clients Unduplicated Clients132 Male72% Female28% New Clients26% Latino/a Clients80% No Insurance83% Offers HIV Counseling/Testing (HCT)1,500 tests Anonymous86% Confidential14%

11 ADDRESSING THE NEEDS OF LATINO/As FY 2002 Needs Assessment: 48% of the PLWH/A reported that a major barrier to the their care was the inability to communicate or interact with their service provider Title VI of the Civil Rights Act of 1964/ California’s 1973 Dymally-Alatorre Bilingual Services Act: requires health care facilities receiving federal/state funding to provide competent interpretation services

12 ADDRESSING THE NEEDS OF LATINO/As Improving Translation/Interpretation: Healthcare Interpreter Training—   Comprehensive curriculum for basic interpreting skills   Healthcare and medical terminology Translation Services—   All key documents translated into Spanish Modification of Standards—   Demonstrate cultural/linguistic competency   Medical outpatient providers expected to engage/use bilingual staff

13 ADDRESSING THE NEEDS OF LATINO/As Expanding Service Delivery: Mobile Dental Clinics—   Moving services into the two remaining SPAs without oral health services Mobile Medical Clinics—   Increasing services and availability for hard-to-reach, especially Latino, populations

14 ADDRESSING THE NEEDS OF LATINO/As Enhancing Trainings: Incorporating “Multi-Cultural Sensitivity: Under- standing and Expanding Cultural Norms” into prevention case management, case management certification and counseling/testing trainings—   Client-centered perspective   Defines culture and oppression   Explores belief systems   Exercises to uncover/examine biases

15 ADDRESSING THE NEEDS OF LATINO/As Developing New Models of Care for Underserved Populations: TB Adherence Study—   23% of TB cases in Latino communities   Tracking sample population to ensure follow-up/adherence   Studying co-morbidity/psychosocial behavior DART (Directly Administered Anti-Retroviral Therapy—   “ Directly observed”, observing clients taking meds   Intensive case management regularly assessing and addressing barriers to adherence

16 ADDRESSING THE NEEDS OF LATINO/As Developing New Models of Care for Underserved Populations (cont.) : CDP (Corrections Demonstration Project)—   Transitional case management, HIV education and risk reduction, treatment adherence within the jails SPNS Prevention with Positives—   Incorporating prevention messages into medical outpatient appointments   Assess and tailor prevention messages to client risk behaviors   Providing regular “prevention prescriptions”

17 ADDRESSING THE NEEDS OF LATINO/As Developing New Models of Care for Underserved Populations (cont.) : Prevention of Perinatal HIV Transmission Project—   Peer health educators (“promotoras”) trainings   Dissemination of social marketing campaigns   Directed at women of childbearing age SPNS Young MSM of Color (proposing) —   Integrated case management, outreach and peer support activities for target population

18 ADDRESSING THE NEEDS OF LATINO/As Systemic Coordination of Services: Establishing Service Provider Networks (SPNs) to coordinate local services Requiring “liked referrals” and follow-up Cross-Title collaboration efforts SPNS HIV Interface Technology Systems (HITS)—   Immediate referral from disclosure into care   Easing entry into care   Reminders and follow-up from counselors and care professionals