3. Location of the Integrated Care Clinic ¨Dr. Issac Cohen Alcahé¨

4. Principal Areas where Indigenous Peoples live

5. Issue: Official AIDS cases in Guatemala are not reported by ethnic groups. There are a large percentage of persons living with HIV/AIDS that are from the Mayan ethnic groups. Our hypothesis is that culture is the foundation for integrated care of Indigenous persons living with HIV.

6. Objetivo We implemented this study to describe concrete elements that secure cultural respect and can be integrated in adherence counseling for this underserved population.

7. Description: We implemented a study among 240 Indigenous persons infected with HIV from the integrated care clinic in Quetzaltenango, Guatemala. We designed, validated and administrated a structured questionnaire that measures: demography, experiences in HIV integrated care clinics, socioeconomic and cultural factors that influence in adherence and integrated care, the need to speak in the Indigenous language, concepts regarding sickness and health, spiritual and religious perceptions.

8. Characterization of Group: Ethnic Groups by sex

9. Ethnic Group

10. Preference and comprehension of language among Mayan peoples.

11. Occupation Promedio de ingreso mensual: Q.729.00

12. Education

13. Religion

14. ART by Sex group

15. Persons with ART by Ethnic Group

16. Lessons Learned: Adherence Levels by ethnic group

17. Lessons Learned It was necessary to explain HIV/AIDS, ART treatment and the nature of ART medication in the Mayan language within the socio-cultural context of the person. 70% of the Indigenous patients manage a different concept of sickness and health than the western perspective. Sickness and health is based on communal perceptions rather than individualistic aspects.

18. How to interpret what it means to be HIV infected

19. Part of Life CARGA or Challenge There isn´t a feeling that anyone should be blamed The person accepts their condition as HIV positive person Actions are oriented to improve their future. Is a responsability An opportunity to raise their values to another level To devote themselves to self-care They have a personal goal that their life will be useful and dedicated to serving others. It is their hope that they will become a great person and community leader.

20. Leaders (K’amal B’e) Challenge/Candidates for Service (Eqomal) Sick Person (yawab’)

21. Lessons Learned There are persons in one´s life that can help with the adherence. Use religion or spirituality to improve ART treatment.

22. Recieve Family Assistance

23. Next Steps Dialogue about HIV and AIDS as part of the oral tradition, transmiting a vision of NO discrimination among HIV+ persons. Advocate among leaders and community authorities to bring support to the integrated care HIV clinics (this includes assisting with adherence to HIV therapy) Propose to other integrated care clinics to take steps in complementing the vision that the Indigenous populations have regarding sickness and health.

24. Thank You