NHMA 15 th Annual Conference Decreasing Infectious Diseases Among Hispanics Dr. Vargas-Jackson March 2011

Hispanics/Latinos in the United States and HIV/AIDS F As the largest minority group in the U.S., Hispanics are disproportionately affected by HIV/AIDS. In 2006, Hispanics comprised 15% of the U.S. population or 44.3 million people, yet represented 18% of the HIV/AIDS cases that same year, among 33 states with name-based reporting, excluding Puerto Rico. Among Hispanics/Latinos, males had a higher AIDS rate (per 100,000) of 31.3, than females, 9.5.

Hispanic/Latina Women and HIV/AIDS For Hispanic/Latina women living with HIV/AIDS, the most common methods of HIV transmission: 1) High-risk heterosexual contact and 2) Injection drug use (IDU) In 2006, the majority of Latinas living with HIV/AIDS were infected through heterosexual contact- approximately 70% of Latinas.

Hispanic/Latino Men who have sex with men (MSM) For Latino men living with HIV the most common mode of transmission is sexual contact with another man. At the end of 2005, 57% of all Hispanics living with HIV/AIDS in the U.S reported male-to-male sexual contact as the transmission category, compared to 49% among Blacks.

Hispanics/Latinos, Drug Use, and HIV/AIDS Communities of Color in the U.S. are most heavily affected by AIDS associated with substance use. At the end of 2006 in 33 states with confidential name- based reporting, 14,427 male adult or adolescent Hispanics living with HIV/AIDS became infected through injecting drugs with HIV contaminated needles, representing 23% of Hispanic males living with HIV/AIDS.

Hispanic/Latino Youth and HIV/AIDS Hispanic/Latino adolescents in the U.S. face unique obstacles that help account for their disproportionately high rate of HIV infection. Hispanic/Latino teens aged accounted for 19% of AIDS cases among U.S. teens in 2006 although they represented 17% of the U.S. teen population that same year.

Cultural Barriers & Misunderstandings Among the barriers preventing Hispanics/Latinos from acquiring information, increasing knowledge and accessing services, some of the most important are: F Lack of Health Literacy F Health related Stigma F Other Cultural Factors

Stigma Definition F Negative feelings, beliefs and behaviors directed toward an individual or group due to a particular label or characteristics. Stigma is the result of existing stereotypes, prejudices, biases, and other forms of oppression in our society, directed at individuals and/or groups.

Health Related Stigma Definition Stigma is a social opportunistic disease that attaches to many illnesses, such as: HIV, mental disorders, drug abuse, tuberculosis, etc. It Decreases prevention & access to care and services success, and increases intolerance, and mortality rates

The Attitude That Spreads HIV F Stigma has become a major reason why HIV epidemic continues and millions of people are newly infected and dying with HIV every year.

HIV Related Stigma Using HIV as an Example: a) Primary HIV Stigma is directed at those individuals who are infected and/or those perceived as infected with the virus b) Secondary HIV Stigma is aimed at those individuals and/or groups associated with those infected, such as: partners, family members, friends, health care providers, volunteers and agencies working with those infected

Health Literacy Definition F Is the degree to which individuals have the capacity to obtain, process and understand health information and services needed to make appropriate health decisions, in a particular language

Health Literacy FACTS F Low health literacy is a major source of economic inefficiency in the health care system F Magnitude of cost ranges from $106 billion to $238 billion annually F When one accounts for the future cost of low literacy that results from current actions (lack of action) cost of low health literacy is closer to $1.6 trillion to $3.6 trillion ( Vernon, Trujillo, Rosenbaum, DeBuono, 2007)

Culture F Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of ethnic, religious or social groups.

Cultural & Linguistic Competence Cultural & linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.

Cultural & Linguistic Competence Implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by patients/families, and their communities In summary, IT IS A SKILL

Cultural & Linguistic Competence in Health Care F National Standards for Culturally and Linguistically Appropriate Services in Health Care: March 2001 F 14 Standards F Standards currently being revised/updated

Global Center for Stigma & Health Literacy “Cultural Competence in Health Care” “The Center” The primary motivation for Howard University and its Partners to launch “The Center” is: To practice and teach Cultural Competence in Health Care, increase Health Literacy skills and eliminate STIGMA The Center : Is not the expression of any specific Culture; It is the acceptance of our own Humanity; “that we are ONE despite our differences”

Why a Center: Health Care is a Cultural Construct Culture: particularly Health Literacy, & Stigma defines: -how health care information is received -how rights and protections are exercised -what is considered to be a health problem -how symptoms/concerns about the problem are expressed - who is stigmatized, stereotyped, & discriminated against -who should provide treatment for the problem -what type of treatment should be given, among other things

1- Why a Center? Because we need to become a Forum for a network of agencies, organizations & participants working on: HL/S We need to establish a Global Knowledge Network on Stigma Reduction & increased Health Literacy skills We need to Develop a Society-wide Health Response to eliminate Health Disparities Because we need to fight for Health as a Human Right Because Stigma is the attitude that spreads HIV

2- Why a Center ? We need to bring together diverse stakeholders to share experiences, knowledge, tools & research around Stigma & Health Literacy We need to foster innovative solutions & expand the reach of existing ways to reduce Stigma & Increase Health Literacy We need to facilitate research across disciplines to expand evidence–based impact of Stigma and Health Literacy intervention efforts

Howard University and Partners Launched the: Global Center for Stigma and Health Literacy “Cultural Competence in Health Care” December 1, 2010

Global Center for Stigma & Health Literacy “Cultural Competence in Health Care” “The Center” Vision is: A Culturally Competent, Health Literate world free of health related Stigma The Center : Is not the expression of any specific culture ; It is the acceptance of our own Humanity; “that we are ONE despite our differences”

Global Center for Stigma & Health Literacy “Cultural Competence in Health Care” Mission To improve health outcomes and decrease health disparities by eliminating health-related Stigma; promoting cultural competence in health care with emphasis on health literacy at providers and populations ends

Center’s Main Areas  Conduct Assessments and Research at providers and community ends  Development of Culturally appropriate Markers, Tools and Interventions  Provide Training, Technical Assistance & Capacity Building  Monitor & Evaluate all programmatic aspects on constant basis  Develop Publications & Disseminate best practices & other relevant Information

The Center Summary In summary, “The Center” will continue the development of a Culturally Competent, Society-Wide Health Response & Fight for Health as a Human RIGHT Rebecca Vargas-Jackson, M.D.

2011 International Stigma Conference Info: wwwwWhoCanYouTell.com F December 1 & 2, 2011 F Broadcasted worldwide by WHO/PAHO F Free for live and web participants F Bi-lingual, English/Spanish F Some partners are: GWU, Georgetown, Catholic University, Universidad del Caribe, UDC, University of California San Diego, several CBOs and FBOs, HRSA, CDC, National Hispanic Health Professional Schools, NAPWA, Congressional Black Caucus, NHMA

2011 International Stigma Conference (202) Rebecca Vargas-Jackson, M.D.