1. Latinos and HIV/AIDS Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association

6. Midwest AIDS Prevention Project (MAPP) Dedicated to providing high-quality, innovative, evidence-based health education, harm reduction and disease prevention programming and promoting tolerance and understanding, healthy lifestyles, and health services for all people in the region, including those living HIV/AIDS. Dedicated to providing high-quality, innovative, evidence-based health education, harm reduction and disease prevention programming and promoting tolerance and understanding, healthy lifestyles, and health services for all people in the region, including those living HIV/AIDS. Audiences targeted have included teens, college students, gays and lesbians, women, people of color, health care workers, church groups, HIV outreach workers, Latino, Asian, and Arabic communities, and others. Audiences targeted have included teens, college students, gays and lesbians, women, people of color, health care workers, church groups, HIV outreach workers, Latino, Asian, and Arabic communities, and others.

9. Youth and HIV/AIDS Latino youth exhibit high levels of sexual risk behavior and are at increased risk due to their lack of perceived vulnerability Latino youth exhibit high levels of sexual risk behavior and are at increased risk due to their lack of perceived vulnerability HIV infections in 13-19-year-old Latino males was among Men having Sex with Men (50%) HIV infections in 13-19-year-old Latino males was among Men having Sex with Men (50%) 13- to 19-year-old Latina females, however, heterosexual contact accounted for 50% of the new and cumulative cases of HIV infection. 13- to 19-year-old Latina females, however, heterosexual contact accounted for 50% of the new and cumulative cases of HIV infection.

10. Latino Issues and AIDS Latinos with HIV/AIDS more likely to be publicly insured or uninsured Latinos with HIV/AIDS more likely to be publicly insured or uninsured Insurance status can also vary at the time of HIV diagnosis Insurance status can also vary at the time of HIV diagnosis Immigration issue ---inadmissability of HIV/AIDS policy being questioned by – could be done by Congress or Administration by visa waiver option Immigration issue ---inadmissability of HIV/AIDS policy being questioned by – could be done by Congress or Administration by visa waiver option

11. Latino Issues and AIDS Diagnosis at later stages of disease leads to lesser survival Diagnosis at later stages of disease leads to lesser survival Unawareness of risk or disease leads to increased transmission to others Unawareness of risk or disease leads to increased transmission to others Hispanics twice as likely to have STDs compared to Caucasians (gonorrhea, syphilis) and 3x for chlamydial infection –increasing likelihood of HIV transmission Hispanics twice as likely to have STDs compared to Caucasians (gonorrhea, syphilis) and 3x for chlamydial infection –increasing likelihood of HIV transmission Low income challenges Low income challenges Stigma in families, denial, mistrust of health system Stigma in families, denial, mistrust of health system Strong family ties – US and Mexico, mainland and Puerto Rico Strong family ties – US and Mexico, mainland and Puerto Rico

12. Cultural Competence Latino culture – variable by subgroup, but strong and family oriented Latino culture – variable by subgroup, but strong and family oriented Health care system not attuned to cultural competence Health care system not attuned to cultural competence Language services needed to respect culture Language services needed to respect culture Staff training, organizational commitment in cultural competence is needed for the non- Latino health care systems, providers Staff training, organizational commitment in cultural competence is needed for the non- Latino health care systems, providers

13. Financing Medicaid – largest funder Medicaid – largest funder Health Insurance Health Insurance Ryan White CARE Act Ryan White CARE Act IOM 2005 Report: “Public Financing & Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White” – patchwork of services, ineffective approach to managing the epidemic IOM 2005 Report: “Public Financing & Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White” – patchwork of services, ineffective approach to managing the epidemic

14. Federal Trends CDC 2006 – all Americans age 13-64 to be tested for HIV as part of routine medical care, since so many unaware of their status and take steps to treatment if they are aware CDC 2006 – all Americans age 13-64 to be tested for HIV as part of routine medical care, since so many unaware of their status and take steps to treatment if they are aware CDC funding rapid HIV tests CDC funding rapid HIV tests Ethical dilemma: Goal to increase from 75 %– 95% persons knowing they are infected will require more resources than available at CDC Ethical dilemma: Goal to increase from 75 %– 95% persons knowing they are infected will require more resources than available at CDC

15. Minority AIDS Initiative US Department of Health and Human Services Office of Minority Health grants and coordinates activities US Department of Health and Human Services Office of Minority Health grants and coordinates activities HIV/AIDS Policy Office HIV/AIDS Policy Office NIH/NIAAID/NCMHD – Strategic Plans for Disparities NIH/NIAAID/NCMHD – Strategic Plans for Disparities AHRQ – Annual Health Disparities Report AHRQ – Annual Health Disparities Report CDC and HRSA and SAMHSA CDC and HRSA and SAMHSA

16. Minority AIDS Initiative Became authorized in the Ryan White CARE Act this year Became authorized in the Ryan White CARE Act this year Targets minority communities: Targets minority communities: Technical assistance and infrastructure Technical assistance and infrastructure Access to prevention and care Access to prevention and care Build community linkages for HIV prevention/care Build community linkages for HIV prevention/care Congressional Tri Caucus – Disparities Bill; Health Care Summit – July 20-21, San Diego Congressional Tri Caucus – Disparities Bill; Health Care Summit – July 20-21, San Diego

17. Recommendations Systemic approach needed to reduce poverty : housing, jobs, immigration reform, language and stress with acculturation, prison population Systemic approach needed to reduce poverty : housing, jobs, immigration reform, language and stress with acculturation, prison population Mind –body : need to focus on improving quality of life for Latinos w/HIV/AIDS Mind –body : need to focus on improving quality of life for Latinos w/HIV/AIDS Reduce discrimination and stigma with MSM Reduce discrimination and stigma with MSM Reduce injection drug use factor – treatment programs, needle exchange programs Reduce injection drug use factor – treatment programs, needle exchange programs

18. Recommendations Community Leadership Community Leadership Capacity building of CBOs in our communities Capacity building of CBOs in our communities Advocacy to Legislators on need for expansion of programs targeted to Latinos Advocacy to Legislators on need for expansion of programs targeted to Latinos Cultural Competence Curriculum in medical education, CME Cultural Competence Curriculum in medical education, CME Research and Clinical Trials – Latino inclusion Research and Clinical Trials – Latino inclusion

19. Latino Physicians Issues There is a need for more Latino physicians with growth of Latinos with HIV/AIDS There is a need for more Latino physicians with growth of Latinos with HIV/AIDS Latino physicians are 5% of the total physicians in the U.S. –and there is a physician shortage Latino physicians are 5% of the total physicians in the U.S. –and there is a physician shortage HCOP and COE programs (Title VII, PHS Act) recruit Latino students to medicine but need support from Congress and White House to continue HCOP and COE programs (Title VII, PHS Act) recruit Latino students to medicine but need support from Congress and White House to continue Health Professions Diversity is a national priority especially at this time of MD shortage, baby boomer increasing demand –need for political leadership Health Professions Diversity is a national priority especially at this time of MD shortage, baby boomer increasing demand –need for political leadership

20. National Hispanic Medical Association Est. in 1994 in Washington, DC with mission to improve health of Hispanics & other underserved in the U.S. Est. in 1994 in Washington, DC with mission to improve health of Hispanics & other underserved in the U.S. NHMA Leadership Fellowship Program NHMA Leadership Fellowship Program NHMA Council of Medical Societies NHMA Council of Medical Societies Advocacy with Congressional Hispanic Caucus Advocacy with Congressional Hispanic Caucus Annual Conference – April 17-20 th, 2008, Hilton Towers Hotel, Washington, DC Annual Conference – April 17-20 th, 2008, Hilton Towers Hotel, Washington, DC www.HispanicHealth.info; www.nhmamd.org www.HispanicHealth.info; www.nhmamd.org www.HispanicHealth.infowww.nhmamd.org www.HispanicHealth.infowww.nhmamd.org

21. NHMA Council of Medical Societies – States Arizona Latino Medical Association Arizona Latino Medical Association California Latino Medical Association California Latino Medical Association Arkansas Latin American Medical Assoc Arkansas Latin American Medical Assoc Illinois Hispanic Medical Assoc Illinois Hispanic Medical Assoc New Mexico Hispanic Physician Assoc New Mexico Hispanic Physician Assoc Spanish Amer Med-Dent Assoc of NY Spanish Amer Med-Dent Assoc of NY Hispanic Amer Assoc of Louisiana Hispanic Amer Assoc of Louisiana

22. Medical Societies - Other El Paso El Paso San Antonio San Antonio Houston Houston Memphis Memphis Rochester Rochester Bolivian - American Bolivian - American Columbian - American Columbian - American Peruvian - American Peruvian - American Dominican - American Dominican - American Salvadoran – American and Puerto Rico Salvadoran – American and Puerto Rico

23. National Hispanic Health Professionals Leadership Network NHMA Council of Medical Societies NHMA Council of Medical Societies NHMA Physician Fellows Leadership Network NHMA Physician Fellows Leadership Network NHMA Resident Leadership Network NHMA Resident Leadership Network National Association of Hispanic Nurses (NAHN) National Association of Hispanic Nurses (NAHN) Hispanic Dental Association (HAD) Hispanic Dental Association (HAD) National Hispanic Mental Health Assoc National Hispanic Mental Health Assoc National Latino Forum of Health Executives National Latino Forum of Health Executives Latino Caucus of American Public Health Assoc Latino Caucus of American Public Health Assoc Latino Section of American Dietetic Association Latino Section of American Dietetic Association OMH Regional Offices & Contacts OMH Regional Offices & Contacts Hispanic-Serving Health Professions Schools Hispanic-Serving Health Professions Schools Hablamos Juntos Hablamos Juntos

24. National Hispanic Health Foundation NHMA’s 501c3 Foundation NHMA’s 501c3 Foundation Affiliated with the Robert F. Wagner Graduate School of Public Service, New York University Affiliated with the Robert F. Wagner Graduate School of Public Service, New York University Research Training and White Papers on Hispanic health policy Research Training and White Papers on Hispanic health policy Scholarships for Hispanic health professional students Scholarships for Hispanic health professional students www.nhmafoundation.org or at www.nyu.edu www.nhmafoundation.org or at www.nyu.edu www.nhmafoundation.orgwww.nyu.edu www.nhmafoundation.orgwww.nyu.edu