Cultural Competency, HIV, & Stimulants

HIV, Mental Health, the Brain, & Stimulants

January 31, 2006I. Jean Davis, PhD, DC, PA

Assistant Professor, Dept. Internal Medicine Charles R. Drew University of Science & Medicine

University of California, Los AngelesCo- Principal Investigator & Director,

Pacific and National Minority AIDS Education & Training CentersWatts HealthCare Corp. HIV/AIDS Clinician

William D. King MD JD Visiting Assistant Physician UCLA Dept. of Infectious Diseases; UCLA Integrated

Substance Abuse Programs, THE Clinic Staff HIV Physician

Objectives

At the end of this presentation, participants will be able to:

• Discuss cultural competency in the context of HIV and stimulant use

• Review participants' experiences with methamphetamine and cocaine users

• Identify barriers to care for stimulant using patients living with--or at risk for--HIV/AIDS

• Consider approaches to better serve patients impacted by these epidemics  

Definitions

• Culture– The complex whole which includes knowledge, belief,

art, morals, law, custom, and other capabilities and habits acquired by man as a member of society

• Cultural Competency– A set of congruent behaviors, attitudes, and policies

that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations

Health Disparities & Cultures

• Culture plays an important role in determining health related beliefs and practices.

• Individuals from specific cultures may require screening for diseases that are more prevalent in that culture, react differently to medicines or use traditional healing practices.

• Health care delivery organizations are legally required to respond to language and cultural needs of their service area by becoming “culturally competent.” (Brach et al, 2000)

Cultural Competence

• Awareness and acceptance of differences

• Awareness of own cultural values

• Awareness of dynamics of differences

• Development of cultural knowledge

• Ability to work within other’s cultural context

• Healthy self-concept

• Free from ethnocentric judgment

Why Cultural Competence is Important

Disproportionate Incidence of New Cases of HIV/AIDS in People of Color in 2002

Total US PopulationTotal US Population(n=288,369,000)(n=288,369,000)

White*69%

Black*Black* HispanicHispanic

OtherOther

12%12%13%

5%

15

30

45

60

Black* White* Hispanic Black* White* Hispanic

54%54%

26%26%19%19%

New HIV CasesNew HIV Cases(n=40,000)(n=40,000)

Cas

es (

%)

Cas

es (

%)

15

30

45

60

Black* White* Hispanic Black* White* Hispanic

50.4%50.4%

28.4%28.4%

19.6%19.6%

New AIDS CasesNew AIDS Cases(n=42,024)(n=42,024)

Cas

es (

%)

Cas

es (

%)

*Not Hispanic.CDC: HIV/AIDS Surveillance Report. 12/2003.

Respondent-assessed Health Status

0% 5% 10% 15% 20%

Non-Hispanic

black

Non-Hispanic

white

Total Hispanic

SOURCE: CDC/NCHS, National Health Interview Survey, 1992-1994

Percentage

Fair or poor health (age-adjusted)

0%

5%

10%

15%

20%

25%

30%

35%

Asian Black Latino White

Source: The Commonwealth Fund 2001 Health Care Quality Survey

* Problems include understanding doctor, feeling doctor listened, had questions but did not ask

Percent Facing Difficulty in Communicating* with Physicians

Health Literacy

Why Cultural Competence is Important

• Developing a relationship with your patient that allows you to learn about their culture can improve how you diagnose or treat them.

• Cultural competence facilitates the development of treatment plans that are followed by patients and supported by their families.• enhances compatibility between Western and traditional cultural

health practices

• Cultural competence enhances overall communication and the clinical interaction between provider and patient.

• Bottom line: $$$ Cultural competence can lead to the retention of clients in a very competitive and transitory environment.

Provider Attitudes that Serve as Barriers To Access

• Providers reluctant to prescribe medications to those patients that they believe will be non adherent.

• Bogart and colleagues found that physicians were more likely to provide highly active antiretroviral therapy (HAART) to HIV/AIDS patients when they perceived them to be likely to be adherent.

• Randomly assigned physicians to review patient vignettes that varied only on patient gender, disease severity, ethnicity, and risk group. Physicians were significantly more likely to rate the African American simulated patients as non-adherent.

Bogart et al., 2000; Bogart et al, 2001

Provider Cognition

Provider Behavior

Patient Cognition

Patient Behavior

Unconscious Unconscious or Conscious or Conscious StereotypesStereotypes

Interaction Interaction with Patientwith Patient

Trust, Trust, ComprehensionComprehension

AccessAccess

AdherenceAdherence

Patient-Provider Communication Challenges

• 40-80% of medical information is immediately forgotten

• Almost half is remembered incorrectly

• The more given the more forgotten

• Speaking information – 17%

• Speaking and pictogram- 84%

• Four month recall higher with S and P

Improving Health through Culture Competency

• Recruitment of multicultural staff• Coordinating with traditional healers• Use of community health care workers• Culturally competent health care promotion• Including family and/or community members• Administrative and organizational accommodations• Training programs

(Brach et al, 2000)

Techniques that health care agencies could use to become more culturally competent include:

Organizational Cultural Competence:

A journey, not a destination…

Unaware, Competent

Aware, Incompetent

Aware, Competent

Unaware, Incompetent

Example of Cultural Competency Models for African-Americans & Latinos

Discrimination