1. ADAPs and Minorities: Issues in Access Stephen Jackson, M.P.H. Nebraska Department of Health & Human Services Ryan White Part B Program Manager

2. NASTAD Annual TA Meeting 7/092 Defining the Issues Minorities are disproportionately impacted by HIV/AIDS Minorities are underrepresented in ADAP numbers

3. NASTAD Annual TA Meeting 7/093 CDC Data By Race/Ethnicity, 2007

4. NASTAD Annual TA Meeting 7/094 2009 National ADAP Monitoring Report*

5. NASTAD Annual TA Meeting 7/095 Nebraska Comparison Data

6. NASTAD Annual TA Meeting 7/096 Nebraska Unmet Need Data, 2008

7. NASTAD Annual TA Meeting 7/097 Secondary Issues to Access – NASTAD Survey of States Homelessness Transportation Stigma –Acceptance of diagnosis Late access to care Acceptance of care Poverty Unemployment Disparate healthcare Incarceration Waiting lists Risk behaviors Apathy –Population specific –Testing

8. NASTAD Annual TA Meeting 7/098 Member States Comments Los Angeles, CA: –Lower income, assumedly Medicaid eligible –Late testers Washington DC: –Late access –Intermittent access New Jersey: –AA men underrepresented in ADAP –Hispanics overrepresented in ADAP

9. NASTAD Annual TA Meeting 7/099 Housing issue with Nebraska ADAP Clients Homelessness –African Americans reported 2.3% non-permanent housing to ADAP (total pop) –African Americans non-permanent housing 8.9% within the population

10. NASTAD Annual TA Meeting 7/0910 Secondary Issues to Access – Nebraska ADAP General Assistance Veteran’s Administration –Focus group of AA men 37.5% reported VA is their primary source of HIV care

11. NASTAD Annual TA Meeting 7/0911 Income Levels of Nebraska ADAP Consumers

12. NASTAD Annual TA Meeting 7/0912 Race Troubles: Why Do African Americans Fare Worse (Achieve) –Fight to stay off streets –Fight to stay sober –Poverty –Interpersonal relationships –Distrust of providers –Inadequate health insurance –Racial discrimination

13. NASTAD Annual TA Meeting 7/0913 Race Troubles (continued) Medical issues –Higher infection rates –Didn’t reach treatment goals –Co-morbidities Liver disease Hepatitis C –Less likely to receive treatment –More likely to change providers –More likely to disrupt treatment –More likely to hide diagnosis –Greater number of hospitalizations Late testing Late access Dual diagnosis

14. NASTAD Annual TA Meeting 7/0914 Alternate Points of Care Medicaid/Medicare Private insurance County General Assistance programs Hospital Patient Assistance VA Emergency room access CHIP (high risk insurance pools) Self pay No access

15. NASTAD Annual TA Meeting 7/0915 Effective Ways of Consumer Access to ADAP Collaboration with ASO/CBO/external case management –FQHC –Family planning/family health –Local health departments Referrals from out-of-network providers Outreach funded through RW Part B Peer states connecting consumers Self referral

16. NASTAD Annual TA Meeting 7/0916 References www.cdc.gov 2009 National ADAP Monitoring Report NASTAD Member States Survey University of Nebraska Medical Center ADAP Achieve, Spring 2009, pp 1, 3-4, 7 Race Troubles: Why Do African Americans with HIV Fare Worse?. Acria/GMHC

17. NASTAD Annual TA Meeting 7/0917 Stephen G. Jackson, MPH 301 Centennial Mall South, 3 rd Floor Lincoln NE 68509-5026 402.471.2504 402.742.8328 FAX Steve.jackson@nebraska.gov