Positive Women’s Network-USA October 8, 2013 For Audio: Dial-in#: Participant Code: #

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

3 For more information:  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  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  All webinars are recorded - do not use identifying information when asking questions Participation Guidelines For Audio: Dial-in#: Participant Code: #

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 – “Resources” tabwww.incarecampaign.org For Audio: Dial-in#: Participant Code: # Participation Guidelines

Engaging and Retaining Women Living with HIV In Care Naina Khanna Executive Director Positive Women’s Network – USA Partners InCare Webinar Oct fb: tinyurl.com/pwnusafacebook

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 fb: tinyurl.com/pwnusafacebook

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

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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 fb: tinyurl.com/pwnusafacebook

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. fb: tinyurl.com/pwnusafacebook

Structural Barriers fb: tinyurl.com/pwnusafacebook

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fb: tinyurl.com/pwnusafacebook “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.”

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Stigma-Related Barriers fb: tinyurl.com/pwnusafacebook

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Provider-Patient Interactions fb: tinyurl.com/pwnusafacebook

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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? fb: tinyurl.com/pwnusafacebook N = 122 Source: PWN-USA SRHR Online Survey, August 2013

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Reproductive Health and Rights fb: tinyurl.com/pwnusafacebook

Trauma History fb: tinyurl.com/pwnusafacebook

Trauma History fb: tinyurl.com/pwnusafacebook

Trauma History fb: tinyurl.com/pwnusafacebook

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 fb: tinyurl.com/pwnusafacebook

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 fb: tinyurl.com/pwnusafacebook

What Works fb: tinyurl.com/pwnusafacebook 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

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fb: tinyurl.com/pwnusafacebook Panelists: Loren Jones Oakland CA Independent Policy Advisor Diagnosed: 1985 Jay Conner San Diego, CA Peer Navigator, Christie’s Place Diagnosed: 1996 Expert Panel

Questions? fb: tinyurl.com/pwnusafacebook

Thank you Naina Khanna Executive Director Positive Women’s Network – USA fb: tinyurl.com/pwnusafacebook

36 Campaign Headquarters: National Quality Center (NQC) 90 Church Street, 13 th floor New York, NY Phone Visit Web / Open the Toolkit - “Partners” tab Sign up for Partners in+care Network – “Partners” tab Join Facebook Send to – “Facebook” in subject line Partners in+care Resources