1. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Training Providers Who Serve Mono/Bilingual Spanish- Speaking Clients Tom Donohoe, MBA Octavio Vallejo, MD, MPH UCLA Pacific AIDS Education and Training Center

2. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e

3. People living with HIV in the USA. 2003 230,000 200,000 130,000 340,000 Infected without Knowing their HIV Status 180-280K Knowing their HIV In medical care With AIDS diagnosis

4. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Minorities of Color and HIV Three of every five new AIDS cases in men were among minorities (63.8 percent) Four of every five new AIDS cases in women were among minorities (81.9 percent) Four of every five new AIDS cases in children were among minorities (85.6 percent) Ryan White Comprehensive AIDS Resource Emergency (CARE) Act. 2002

5. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e LATINOS What have we learned? The percentage of new AIDS cases among Latino/as has increased in the last 15 years In California Latino/as are the 30.8% of the total population yet now account for 34.9% of the AIDS cases. Latino/as receive an AIDS diagnosis at early ages (< 30 year-old) HIV transmission occurs more frequently among (MSMs and women for heterosexual contact).

6. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Latinos and HIV Increase in number of new infections Increase in number of Latinos/as newly diagnosed with AIDS Too late detection of HIV status Late access to health care Misperceptions and ignorance about the U.S. health care system Language barriers

7. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Latinos and HIV Translators Translations often conducted by office staff and family, including children Even professional translators report difficulty translating technical, medical, and personal (sexual, drug/physical abuse) information Translators need training too!

8. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Culture and HIV

9. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Culture and HIV Introduction Culture as a body of learned behaviors common to a given human society, acts rather like a template, shaping behavior and consciousness within a human society from generation to generation - Systems of meaning (language) - Ways of organizing society

10. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Culture involves at least 3 components: What people think What they do Material products they produce. Thus mental processes, beliefs, knowledge, and values are parts of culture. Mental rules guiding behaviors (according to some anthropologists)

11. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e We would like to….. Increase awareness of cultural competence Understand the elements of cultural competence in health care Apply cultural competence mindset to your job/responsibilities

12. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Cultural Competency in the Health Care Setting Set of attitudes, skills, behaviors, policies –Enables organizations and individuals to work effectively cross-culturally –Understands importance of health-related beliefs, attitudes, and practices communication patterns of beneficiaries –Eliminates disparities in health status

13. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e When we say that a health care setting is cultural competent ? When this setting has demonstrated awareness and integration of three population specific issues – health-related beliefs and cultural values – disease incidence and prevalence – treatment efficacy

14. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Organizational Cultural Competence A journey, not a destination... Unaware, Competent Aware, Incompetent Aware, Competent Unaware, Incompetent

15. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Cultural Competence Awareness and acceptance of differences Awareness of owns cultural values Awareness of dynamics of differences Development of cultural knowledge Ability to work within others cultural context Healthy self-concept Free from ethnocentric judgment

16. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e The AWARE Model Communication Across Cultures A ccept the other persons behavior without judging it based on what that behavior means in your culture W onder what the persons behavior means in his/her culture, rather than what it means in your culture A sk what it means to the person, showing a respectful interest Noel Day, Polaris Research & Development

17. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e The AWARE Model Communication Across Cultures R esearch and read about other persons culture so you are able to place their behavior in the context of their cultural word view E xplain what the behavior means in your culture. Demonstrate and or describe the behaviors in your culture that would express similar feelings or meanings Noel Day, Polaris Research & Development

18. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Latinos and the US Health Care System The concept of developing relationships with medical providers and becoming part of the team care is a foreign concept First of all, it is necessary to encourage patients to educate themselves about all his/her options, how to express their opinions, concerns, doubts and disagreements

19. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Latinos and HIV Treatment services must take account: Latinos appreciate mutual respect in social relationships, especially with authority figures. They strive to preserve personal integrity in interactions with others. A person receiving medical or drug treatment must feel that he or she is treated with respect and valued, or treatment will be rejected.

20. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Latinos and HIV Treatment services must take account: Latinos have a different perception of time, with a more flexible understanding of punctuality. Saving time is seen as less important than smooth, warm social relationships. A Latino patient may see as rudeness a hurried pace or focus on saving time on the part of a caregiver.

21. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Latinos and HIV Treatment services must take account: Familismo.- Emphasis on the family as the primary social unit and source of support. Strong ties within Latino families. Simpatia.- The importance in the culture of polite and cordial social relations. (central cultural value and social expectation).Shuns assertiveness, direct negative responses and criticism. Como Usted diga

22. A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e Latinos and HIV Treatment services must take account: Personalismo.- Latino preference for relationships with others that reflect a certain familiarity and warmth. Latino may be more likely to trust and collaborate with someone with whom they had pleasant conversations. We need a friend and support in the fight against this disease. Sometimes the providers are extremely cold and professional.