1. Positive Women’s Network-USA October 8, 2013 For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#

2. 2 Agenda 1. Welcome & Introductions, 5min 2. PWN Explores Retention, 30min 3. Panel Discussion, 20min 4. Announcements, 5min In the chat room, Enter your: 1. name, 2. agency, 3. city/state, and 4. professional role at agency Michael Hager in+care Campaign Manager National Quality Center New York, NY michael@nationalqualitycenter.org

3. 3 For more information: www.incarecampaign.org  This Partners in+care webinar is offered as part of the in+care Campaign.  The in+care Campaign is a national effort to improve retention in HIV care.  Webinars are one of many Partners in+care activities designed to engage people living with HIV/AIDS and their allies in the in+care Campaign. Welcome & Overview

4. 4  This is a “public event.” If you have confidentiality concerns:  Your names appear on-line in the list of webinar registrants -consider just listening to the audio or to viewing the webinar at a later time, after it is posted at www.incarecampaign.org  All webinars are recorded - do not use identifying information when asking questions Participation Guidelines For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#

5. 5  Actively participate and write your questions into the chat area during the presentation; we will pause for conversation during the webinar  Do not put us on hold  Mute your line if you are not speaking (press *6, to unmute your line press #6)  The slides and recording of this and other Partners in+care webinars are available for playback and group presentations at www.incarecampaign.org – “Resources” tabwww.incarecampaign.org For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368# Participation Guidelines

6. Engaging and Retaining Women Living with HIV In Care Naina Khanna Executive Director Positive Women’s Network – USA Partners InCare Webinar Oct 2013 www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

7. Overview 1.The cascade for women 2.Barriers and Challenges a.Structural b.Provider-Patient Interactions a.Trauma as a factor b.Discrimination c.Communication c.Stigma-related d.Trauma History 1.What works? Innovations and success 2.Introduction of Panelists 3.Q & A www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

8. SOURCE: CDC, Fact Sheet – HIV in the United States: The Stages of Care; July 2012. The HIV Treatment Cascade Among Women

9. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

10. Factors impacting the Cascade Structural Barriers Cost (co-pays, etc) Transportation Housing Geography Family/work responsibilities Health system level factors – eg. lack of integrated services Access Stigma Cultural Norms & Social Desirability Internalized stigma External stigma Provider -Patient Interactions Communication Power dynamics in relationship Lack of provider expertise Cultural norms Healthcare or social service system as a retriggering/traumatiizing environment Discrimination Health literacy Trauma & Violence Past and present Healthcare & social service system as retriggering environment Engagement in Care www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

11. Structural Barriers  From an individual risk behavior model approach to a structural, environmental and contextual approach  It’s not just about behavior, before or after.  Poverty is a predictor, but also a consequence of HIV diagnosis. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

12. Structural Barriers www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

13. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

14. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org “But I also know that this woman actually has control over what ultimately is a life or death decision with the stroke of her pen. And clearly she is in a bad mood… What I have is a very expensive medical condition and no way to pay for it… it is that simple. I need help. We as women living with HIV are driven into poverty and held there, and we are drowning.”

15. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org 

16. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

17. Stigma-Related Barriers www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

18. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

19. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

20. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

21. Provider-Patient Interactions www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

22. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

23. Has any provider (doctor, nurse, case manager, or peer advocate) ever told you that when your VL is undetectable, you are less likely to pass HIV to an HIV-negative sexual partner? www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn N = 122 Source: PWN-USA SRHR Online Survey, August 2013

24. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

25. Reproductive Health and Rights www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn

26. Trauma History www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

27. Trauma History www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

28. Trauma History www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

29. A Way Forward  From an individual risk behavior model approach to a structural, environmental and contextual approach  It’s not just about behavior, before or after.  Change the context of women’s lives  Change the way we address women’s care www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

30. A Way Forward Systems- level/Structural Improve care and service delivery environments Building women’s skills and self-efficacy Address culture and social environment context Care for WLHIV www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

31. What Works www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org Address lives of WLHIV through interventions that address our lives - eg resume writing, job training, employment preparedness, trauma healing Improve environment of care and service delivery systems – eg trauma- informed care, peer based services, culturally relevant care, provider expertise Address context for WLHIV through systems-level interventions – examples: policy change, integrated services for MH, SA, SRH, & changing cultural norms around HIV

32. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

33. www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org Panelists: Loren Jones Oakland CA Independent Policy Advisor Diagnosed: 1985 Jay Conner San Diego, CA Peer Navigator, Christie’s Place Diagnosed: 1996 Expert Panel

34. Questions? www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

35. Thank you Naina Khanna Executive Director Positive Women’s Network – USA Naina.khanna.work@gmail.com 510.681.1169 www.pwn-usa.org www.pwn-usa.org fb: tinyurl.com/pwnusafacebook tw: @uspwn www.pwn-usa.org

36. 36 Campaign Headquarters: National Quality Center (NQC) 90 Church Street, 13 th floor New York, NY 10007 Phone 212-417-4730 Visit Web / Open the Toolkit www.incarecampaign.org - “Partners” tab www.incarecampaign.org Sign up for Partners in+care Network www.incarecampaign.org – “Partners” tab www.incarecampaign.org Join Facebook Send email to incare@NationalQualityCenter.org – “Facebook” in subject line incare@NationalQualityCenter.org Partners in+care Resources