Download Stories of Success in HIV

Introduction
Charles B. Hicks, MD
Professor of Medicine
Associate Director, Duke AIDS Research and Treatment Center
Duke University Medical Center
Durham, NC
Agenda
• Disparities in HIV/AIDS Care and Communities of Color
• Overcoming Challenges and Barriers to Care in
Communities of Color
• Strategies to Provide Culturally Competent HIV/AIDS
Care
• Strategies to Optimize Testing and Treatment in Patients
with HIV in Communities of Color
Learning Objectives
After completing this program, participants will be better able to:
•Describe the disproportionate impact that HIV has had in communities
of color
• Evaluate successful approaches in screening and linkage to care in
communities of color
•Outline how to implement strategies for screening and linkage to care
in their own clinical practices
•Discuss how the cultural and socioeconomic status of minority patients
impacts their access to HIV testing and access to care
•Develop trusting and productive patient-provider relationships in order
to expand HIV testing and access to care
Accreditation Statement
PHYSICIAN CONTINUING MEDICAL EDUCATION
• Accreditation Statement
This activity has been planned and implemented in accordance with
the Essential Areas and policies of the Accreditation Council for
Continuing Medical Education (ACCME) through the joint
sponsorship of Postgraduate Institute for Medicine (PIM) and
HealthmattersCME. PIM is accredited by the ACCME to provide
continuing medical education to physicians.
• Credit Designation
Postgraduate Institute for Medicine designates this educational
activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™.
Physicians should only claim credit commensurate with the extent of
their participation in the activity.
Accreditation Statement (cont’d)
NURSING CONTINUING MEDICAL EDUCATION
• Credit Designation
This educational activity for 1.5 contact hours is provided by
Postgraduate Institute for Medicine.
• Accreditation Statements
Postgraduate Institute for Medicine is accredited as a provider of
continuing nursing education by the American Nurses Credentialing
Center’s Commission on Accreditation.
• California Board of Registered Nursing
Postgraduate Institute for Medicine is approved by the California Board
of Registered Nursing, Provider Number 13485 for 1.7 contact hours.
To receive Continuing Education Credit for this program, please complete
the evaluation in your meeting folder and return to the meeting organizer in
the back of the room
Disclosures of Relevant Financial Relationships
David Barker, MD, MPH, FACP
W. David Hardy, MD
Consulting Fees: Virco
Consulting Fees: Gilead Sciences,
GlaxoSmithKline, Merck & Co, Monogram
Biosciences, Inc, Pfizer Inc, Tibotec Therapeutics,
ViiV Healthcare
Contracted Research: Gilead Sciences, Merck
& Co, Pfizer Inc, Virco
Edwin DeJesus, MD, FACP
Consulting Fees: Bristol-Myers Squibb, Gilead
Sciences, GlaxoSmithKline, Merck & Co,
Tibotec Therapeutics, Vertex Pharmaceuticals
Contracted Research: Abbott Laboratories,
Achillion Pharmaceuticals, Avexa, Boehringer
Ingelheim, Bristol-Myers Squibb, Gilead
Sciences, GlaxoSmithKline, Hoffman LaRoche
Laboratories, Merck & Co, Pfizer Inc, Schering
Plough, TaiMed Biologics, Tibotec
Therapeutics, Tobira Therapeutics,
Pharmaceuticals
Fees for Non-CME Services: Gilead Sciences,
Merck & Co, Tibotec Therapeutics, Virco
Contracted Research: Bionor Immuno, Gilead
Sciences, Pfizer Inc, Tibotec Therapeutics
Stock: Merck & Co
Charles B. Hicks, MD
Consulting Fees: Bristol-Myers Squibb, Gilead
Sciences, GlaxoSmithKline, Merck & Co, Myriad
Genetics, Inc, Tibotec Therapeutics
Contracted Research: Bristol-Myers Squibb,
Gilead Sciences, GlaxoSmithKline, Merck & Co,
Pfizer Inc, Schering-Plough, Tibotec Therapeutics
Disclosures of Relevant Financial Relationships
Sally L. Hodder, MD
Claudia Martorell, MD, MPH, AAHIVS, FACP
Contracted Research: Bristol-Myers Squibb,
Gilead Sciences, Tibotec Therapeutics
Contracted Research: Bristol-Myers Squibb,
Gilead Sciences, GlaxoSmithKline, Merck &
Co, Tibotec Therapeutics
Consulting Fees: Boehringer Ingelheim, BristolMyers Squibb, Gilead Sciences, Tibotec
Therapeutics
Fees for Non-CME Services: Bristol-Myers Squibb
Fees for Non-CME Services: Bristol-Myers
Squibb, Gilead Sciences, GlaxoSmithKline,
Tibotec Therapeutics
Stock: Merck & Co
M. Keith Rawlings, MD
Wilbert Jordan, MD, MPH
Contracted Research: Gilead Sciences, Hoffman
LaRoche Laboratories
Fees for Non-CME Services: Bristol-Myers Squibb,
Gilead Sciences
Consulting Fees: Abbott Laboratories, BristolMyers Squibb, Gilead Sciences,
GlaxoSmithKline, Tibotec Therapeutics
Fees for Non-CME Services: Abbott
Laboratories, Bristol-Myers Squibb, Gilead
Sciences, GlaxoSmithKline, Tibotec
Therapeutics
Grant Support
This program is supported by an independent
educational grant from Gilead Sciences Medical
Affairs.
Epidemiology of HIV in the US:
Disproportionate Impact of HIV in
Communities of Color
Percentages of AIDS Cases and Population by
Race/Ethnicity, Reported in 2007—50 States and DC
American Indian/Alaska Native
Asian3
Black/African American
1.
2.
3.
Includes 411 persons of unknown race or multiple races.
Hispanics/Latinos can be of any race.
Includes Asian and Pacific Islander legacy cases.
Hispanic/Latino2
Native Hawaiian/Other Pacific Islander
White
Disproportionate Effect of HIV/AIDS in Black
Subpopulations
• Black women
 Accounted for 65% of new AIDS cases among women in the US
in 20071
 Reported an HIV incidence rate 14.7 times higher than white
women in 20062
• Black MSM
 In a study of five large US cities in 2005, 46% of black MSM
(men having sex with men) were infected with HIV, compared
with 21% of white and 17% of Latino MSM3
•
1.
2.
3.
Black adolescents
 Black youth accounted for 68% of AIDS cases among those
ages 13-19 in 2007, while making up just 17% of the population1
Kaiser Family Foundation (KFF). The HIV/AIDS epidemic in the United States. 2009.
CDC MMWR. 2008;57(36):986.
CDC. MMWR. 2005;54(24):599.
Epidemiologic Overview: Disproportionate Effect
of HIV/AIDS in Hispanic Americans
• In 2006, Hispanics
accounted for
approximately 17% of the
new HIV infections1
• In 2007, Hispanics
accounted for 19% of new
AIDS diagnoses1
• In 2007, the annual AIDS
case rate among Hispanics
was 3 times that of whites
(20.4 vs 6.1)1
1. KFF. The HIV/AIDS epidemic in the United States. 2009.
New HIV Infections & US population
by Race/Ethnicity, 20061
Prevalence (%)
HIV Prevalence in Select Countries and in
Subpopulations in the US1
Population
1. El Sadr W, et al, N Engl J Med. 2010;362:967-970.
Disparities in Access to Care
Disparities in Access to Care: Impact on
Clinical Outcomes
• Recent cohort study found blacks spent significantly
smaller proportion of time on antiretroviral therapy
(ART) than whites (47% vs 76%, P<.001)1
 Mortality associated with black race and female sex1
• HIV Outpatient Study: black race independently
associated with 50% higher mortality rate vs whites2
• Non-care-related factors may have an impact
 Socioeconomic factors
 Concomitant diseases and factors may be more common
among minorities (HCV, CHD, substance use)
1. Lemly. J Infect Dis. 2009;199:991-998.
2. Palella. CROI 2008, abstract 530.
Disparities in Access to Care Reflect Disparities in
Income and Insurance Coverage
• Blacks and Hispanics are approximately 3 times more
likely to live in poverty than whites1
• Blacks and Hispanics less likely to have health
insurance, compared with whites2
Insurance Coverage of Nonelderly, by Race/Ethnicity, 20082
1.
2.
DeNavas-Walt. US Census Bureau. Income, Poverty, and Health Insurance. 2008.
Thomas M et al. Health Coverage for Communities of Color, Kaiser Foundation, 2009.
Critical Role of Public Funding for HIV/AIDS
Care in Communities of Color
• Medicaid covers ~40% of
persons with HIV
receiving care in the US1
• Medicare covers ~20%2
 Majority (93%) are under
age 65 and qualify
because they are
disabled
 More likely to be male,
disabled, younger than
65, black, and living in an
urban area than other
Medicare recipients
1. KFF. Fact Sheet: Medicaid and HIV/AIDS, 2009; 2. KFF. Fact Sheet: Medicare and HIV/AIDS, 2009.
Critical Role of Public Funding for HIV/AIDS
Care in Communities of Color
• Ryan White Program funds provide services for
~500,000 people with HIV (fill gaps in Medicaid,
Medicare, and other insurance)1
 Mostly low income and uninsured (33%) or underinsured
(56%)
 72% are people of color
• The AIDS Drug Assistance Programs (ADAPs)
 Provide HIV medications to roughly one-third of patients
receiving care for HIV nationally2
 ~183,000 enrollees nationwide in 20082
1.
2.
KFF. Fact Sheet: Ryan White Program, 2009.
KFF. Fact Sheet: ADAPs, 2009.
Ruth M. Rothstein CORE Center, Chicago,
Illinois
• Public HIV clinic of
Cook County Hospital
 97%-98% publicly
insured
• Receives ~55% of its
funding from a variety
of sources, including
the Ryan White
Program
Percentage
• Approximately 6000
patients, and growing
Population
Meeting the Challenge of Paying for and
Securing Medications: CORE Center
• Despite having an onsite pharmacy, the CORE Center cannot
dispense meds to ADAP patients and be reimbursed (Illinois
ADAP is mail-order only)
• Therefore, 90% of patients use mail order for meds, which
can be a problem for those who lack secure housing
• The CORE Center allows ADAP and other mail order
pharmacies to send meds to CORE, where they are held for
patients
 This work-around benefits patients and saves the county health
system $5.5 million a year
 County expenditures on meds decreased from $17 million in 2000
to $4.5 million in 2008
Overcoming Challenges and Barriers
to Care in Communities of Color
Earlier Access to HIV Testing and Care Is
Needed
• Data indicate minority patients more likely to
enter care later in their HIV disease1-3
• Higher rates of hospitalization reported among
women, blacks, injection drug users (IDU), and
Medicaid and Medicare patients4
• Higher proportion of unrecognized HIV infection
among black and Hispanic MSM5
1. Lemly D et al, J Infect Dis 2009; 2. Keruly JC, et al, Clin Infect Dis 2007; 3. Losina E et al, Clin Infect Dis 2009; 4.
Fleishman JA et al. Med Care 2005. 5. CDC. MMWR. 2005;54(24):599.
Minority Patients May Be More Likely to
Distrust Health Care System
• Distrust may be based on
 History of research abuses in their communities
 Misinformation about origin of HIV epidemic1
 Personal experience of inequitable care by health
care system2
• Distrust may lead to suboptimal adherence3
• Blacks and Hispanics on average have higher
levels of distrust of physicians than do whites4
 Distrust associated with gender, age, insurance
coverage, educational level and income4
1. Bogart. JAIDS. 2005. 2. IOM. Unequal Treatment. 2002; 3. Bogart. JAIDS 2010; 4. Armstrong. Am J Pub Health.
2007.
HIV-Related Stigma Affects Care in
Communities of Color
• Focus group data among low-income black and
Hispanic HIV+ patients reveal stigma on multiple
levels1
 Blame about acquiring HIV and how it was acquired
 Gender stereotypes
 Perceived sexual orientation
• Many patients report stigma in health care setting
 May lead patients to avoid accessing HIV screening
or care until it is urgently needed1,2
 Particular concern among non-gay-identified MSM1
1. Sayles. J Urban Health, 2007. 2. Malebranche. J Natl Med Assoc. 2004.
Incarceration Critical to Spread of HIV in
Minority Communities
• 2.3 million incarcerated persons in 2007
 35.4% were black and 17.9% were Hispanic1
• As many as 17% of all persons with HIV pass
through a correctional facility each year2
• Higher rate of incarceration among black men
impacts HIV/AIDS rates among women of color3
1. CDC, Testing Recommendations in Correctional Settings, 2009; 2. NCCHC Position Statement. 2005. 3. Johnson.
UC Berkeley, 2005.
• AIDS Arms Inc
provides case
management for
patients with HIV
(~2900 patients)
• Primarily Ryan
White funded
Percentage
AIDS Arms Inc & Free World Bound Program,
Dallas, TX
• Developed Free
World Bound
(FWB) program for
former inmates
Population
Free World Bound (FWB) Program, Dallas, TX
• Federally funded program to increase enrollment
of HIV+ ethnic minorities into Texas ADAP postprison
 Prevent interruptions in ARV
 Goal: to enroll 80% of individuals entering the Dallas
area post-incarceration
• Led to marked increase in enrollment for both
men and women
• Program increased from working in 2 prisons to
32 prisons across Texas in 5 years
Kirven D. Poster at Ryan White CARE Act All-Title National Meeting, Washington, DC, August 2008.
Enrollment
Free World Bound: Texas ADAP Male
Enrollment by Race/Ethnicity
Year
Kirven D. Poster at Ryan White CARE Act All-Title National Meeting, Washington, DC, August 2008.
Enrollment
Free World Bound: Texas ADAP Female
Enrollment by Race/Ethnicity
Year
Kirven D. Poster at Ryan White CARE Act All-Title National Meeting, Washington, DC, August 2008.
Strategies to Provide Culturally
Competent HIV/AIDS Care
Strategies to Provide Culturally Competent
HIV/AIDS Care
• Recognize health-related cultural beliefs
• Understand potential difficulties in cross-cultural
encounters1




Gender
Family dynamics
Patient beliefs
Social environment
1. Carillo JE et al. Ann Intern Med. 1999.
Strategies to Provide Culturally Competent
HIV/AIDS Care
• Encourage patient-centered communication
 Minority patients more likely to feel less involved in
health care decisions1
 Minority patients report needing more time with
clinicians to make health care decisions2
 Patients who report that their provider who knows
them “as a person” more likely to3
• Receive ART
• Have better adherence to ART
• Achieve undetectable HIV RNA
1. Cooper-Patrick. JAMA. 1999. 2. Federman. J Gen Intern Med. 2001. 3. Beach. J Gen Intern Med. 2006.
Strategies to Provide Culturally Competent
HIV/AIDS Care
• Having a racially diverse staff has an impact on
patient perceptions of care1
 Racial concordance independently associated with
time to receipt of ART2
• Where possible, it is recommended that clinics
diversify clinical and nonclinical staff to reflect
the communities they serve3
• Growing concern about supply of HIVexperienced clinicians4
1. Cooper. Ann Intern Med. 2003. 2. King. J Gen Intern Med. 2004. 3. Washington. J Gen Intern Med. 2008.
4. Rawlings. XVI Int’l AIDS Conference, 2006; Abst MoPe0643.
Infectious Diseases Clinic and Research Institute,
Springfield, MA
• Fully bilingual
(English/Spanish)
• Focus on culturally
competent care for
patients with HIV,
hepatitis, and
infectious diseases
Percentage
• Large clinical
practice with access
to HIV clinical
research
Population
Infectious Diseases Clinic and Research Institute,
Springfield, MA
• Large proportion of HIV transmission among
males in western Massachusetts related to IDU
 Provide clinical care for HIV/HCV coinfection
• Research Institute initiated to provide access to
clinical research
 Need to address patient perceptions of research by
explaining it carefully to them
 Do not offer research to all patients
• Trial participation based on community needs
Infectious Diseases Clinic and Research Institute,
Springfield, MA
• Fully bilingual staff improves access to care
• Accommodate patient needs
 Importance of bedside manner
 Provide scheduling flexibility
 Protect patient privacy concerns
• Address substance abuse
• Provide case management and get to know the
community
Optimizing HIV Testing and Treatment
in Communities of Color
HIV Testing: CDC Efforts to Identify More
Persons with HIV
• In 2006, the CDC issued new recommendations
for routine opt-out HIV screening in all health
care settings1
 Increase reach of HIV screening
 Identify more people living with HIV
• In 2009 it was estimated that 21% of the more
than 1 million persons with HIV in the US were
unaware of their infection2
1. CDC. MMWR. 2006;55(RR14):1-17. 2. KFF. HIV/AIDS Policy Fact Sheet: HIV/AIDS Testing in the United States,
June 2009.
HIV Testing in US Adults and in Communities
of Color1,2
Percent of non-elderly, ages 18-64, who say they have been tested for HIV
53%
48%
73%
60%
1. KFF. Survey on HIV/AIDS, 2009; 2. KFF. HIV/AIDS Policy Fact Sheet: HIV/AIDS Testing in the United States, June
2009.
Innovations in HIV Testing, OASIS Clinic,
Los Angeles, CA
• The Outpatient Alternative Services Intervention
System (OASIS) Clinic in Los Angeles offers
comprehensive HIV/AIDS testing and clinical
services to patients without regard to their ability
to pay





HIV testing
Early intervention
Outpatient treatment
Chemotherapy
Focused intervention and partner notification program
OASIS Clinic Focused Intervention Program
• Focused intervention and partner notification
program
 Provide incentives for patients to bring in friends and
partners who may be HIV positive for screening
• Has detected a high rate of HIV infection among
those tested through this intervention
• 28% overall HIV positivity1
 Transgender: 45% positive rate
 Formerly incarcerated: 32%
 MSM: 22%
OASIS Clinic: Results of Traditional Intake and
Focused Intervention
Women
Men
Traditional
Focused
Int.
Traditional
Focused
Int.
Patients Testing Positive (2007)
17
7
47
16
Mean CD4 cell count
(cells/mm3)
52
388
104
455
Patients Testing Positive (2008)
6
9
54
22
Mean CD4 cell count
(cells/mm3)
67
399
117
541
Facilitating the Link Between HIV
Testing and Care
Facilitating the Link Between HIV Testing
and Care
• A critical step in the effort to address the needs
of people of color infected with HIV is to ensure
that a diagnosis of HIV infection leads to entry
into HIV care
• For patients outside the traditional health care
system, support services have a positive effect
on their use of medical services1
 Case management, outreach, group visits2,3
1. Cunningham. J Health Care Poor Underserved. 2008. 2. Gardner. AIDS. 2005. 3. Cabral. AIDS Patient Care STDS.
2007.
Optimizing Access to Treatment, Orlando
Immunology Center, Orlando, FL
• Large HIV and HCV
patient populations
(3600 and 700 patients)
Percentage
• Orlando Immunology
Center (OIC) is a private
clinic with no public
funding
• 5 full-time HIV providers
and one case manager
• Research department
conducts Phase I to IV
clinical trials
Population
Continuity of Care, Orlando Immunology Clinic
• Facilitating link between testing and care
 Establish immediate face-to-face contact with clinician
for those who test HIV positive at OIC
 OIC has agreement with local community center
serving gays/lesbians/transgenders to accept
referrals following HIV testing
• Maintaining continuity of care
 Provide services to patients through changes in
insurance status
 Support patients with case management to connect
patients to needed services
Optimizing Treatment with ART in
Communities of Color
Optimizing Treatment with ART in Minority
Patients with HIV
• Treatment recommendations for patients with
HIV in communities of color are not
fundamentally different from those for the
general HIV population
 One anchor drug with dual nucleoside backbone1
 2009 DHHS guidelines added recommendation to
offer ART to patients with CD4 cell counts between
350-500 cells/mm3
1. US DHHS HIV Treatment Guidelines, 2009.
Data on Association Between Race and
Clinical Outcomes
• The literature provides mixed evidence that
treatment choice should be determined by racial
background
 Some cohort data have found associations between
black race and lower response to ART1,2
 Other studies have not identified similar associations,
suggesting outcomes reflect disparities in access to
care and comorbidities3,4
1. Anastos. JAIDS. 2005. 2. Weintrob, JAIDS. 2009. 3. Jensen-Fangel. CID. 2002. 4. Silverberg. AIDS. 2006.
HEAT Trial: Differences in Virologic Outcomes
Associated with Race
HEAT trial:
Proportion of Subjects with HIV-1 RNA <50 c/mL at Week 96; ITT
N
ABC/3TC + LPV/r
TDF/FTC + LPV/r
343
345
1. Smith. IAS 2009, abstract MOPEB033.
119
124
143
147
73
62
8
12
GRACE Trial: Differences in Virologic Outcomes
Associated with Race
GRACE trial: Virologic response (TLOVR) in the ITT population
100
Black (n=264)
Caucasian (n=65)
Hispanic (n=96)
Patients with HIV-1 RNA
<50 copies/mL, %
90
80
70
61.5%
60
50
60.0%
40
48.5%
30
20
10
0
0
8
16
24
Time, weeks
1. Smith. ICAAC 2009, abstract H918.
32
40
48
Facilitating Treatment Initiation
• Strategies to facilitate successful initiation and
continuation of ART
 Cultivate trust in patient-provider relationship1
 Share with patients evidence of regimen’s
effectiveness (eg, improvements in viral load and CD4
cell counts)1
1. Stone. J Gen Intern Med. 1998.
Optimizing ART: Predicting Adherence Is
Difficult
• Clinicians are generally not skilled at predicting
patient adherence or judging who is adherent1,2
• However, certain factors have been shown to be
associated with poor adherence3





Substance use
Low health literacy
Depression
Lack of disclosure of HIV status
Unstable or chaotic living situation
1. Bangsberg. JAIDS. 2001. 2. Miller. J Gen Intern Med. 2002. 3. Golin. J Gen Intern Med. 2002.
Optimizing ART: Strategies for Helping Patients
Adhere
• Assess patient readiness to start ART1
 Inquire about patient’s feelings of readiness and
about belief in medication effectiveness
 Get to know patient’s social situation and availability
of psychosocial support
• Improve patient engagement with provider2
 Assess adherence to appointments3
• Improve patient-provider communication4
1. Enriquez. J Assoc Nurses AIDS Care. 2004. 2. Bakken. AIDS Patient Care STDs. 2000. 3. Lucas. Ann Intern Med
.1999. 4. Schneider. J Gen Intern Med. 2004.
Optimizing HIV Research in
Communities of Color
Improved Minority Representation in
Antiretroviral Clinical Trials
Study
Year
Regimens
Black %
Hispanic %
White %
ACTG 2291
1996
ZDV + SQV
ZDV + DDC
ZDV + DDC + SQV
10
12
73
Study 0062
1999
ZDV + 3TC + EFV
ZDV + 3TC + IDV
EFV + IDV
17
19
60
ACTG 50953
2004
ZDV + 3TC + ABC
ZDV + 3TC + EFV
ADV + 3TC + ABC + EFV
36
21
40
GS 9344
2006
TDF + FTC + EFV
ZDV + 3TC + EFV
23
16
59
HEAT5
2009
ABC/3TC + LPV/r
TDF/FTC + LPV/r
35
20
42
GRACE6
2009
DRV/r + optimized
background regimen
62
22
15
1. Collier. N Engl J Med. 1996. 2. Staszewski NEJM 1997. 3. Gulick NEJM 2004. 4. Gallant. NEJM. 2006. 5. Smith.
AIDS. 2009. 6. Squires. IAS 2009, abst MOPEB042.
• Outpatient HIV clinic
(~3800 patients),
serving Baltimore’s
largely black population
 35% of patients IDU
• Large hepatitis C clinic
due to high prevalence
of IDU in Baltimore
Percentage
Research for Patients With HIV in Communities of
Color, Moore Clinic, Baltimore, MD
• Large HIV database
that supports research
in clinical care among
communities of color
Population
Research at Moore Clinic, Johns Hopkins University,
Baltimore, MD
Percent of Patients
Association between patient perception and clinical outcomes1
Provider Knows Patient as a Person
1. Beach. J Gen Intern Med. 2006.
Research at Moore Clinic, Johns Hopkins University,
Baltimore, MD
Access to care, by proportion of blacks or Hispanics at HIV care site1
Travel time to HIV Care Site
Wait time to see Provider
By proportion Black or Hispanic
By proportion Black or Hispanic
.2
.4
.6
0
.8
.2
.4
.6
.8
45
45
45
45
40
40
40
40
35
35
35
35
30
30
30
30
25
25
25
25
Black
Black
Hispanic
20
20
0
.2
.4
.6
1. Korthuis PT et al, J Gen Intern Med 2006.
.8
Wait time (minutes)
Travel time (minutes)
0
Hispanic
20
20
0
.2
.4
.6
.8
Stories of Success in HIV: Summary
• Disproportionate effect of HIV/AIDS in
communities of color is a key health care
challenge facing minority communities
• Providers in communities of color face many
challenges
 Socioeconomic disparities, including poverty and lack
of insurance, and associated comorbidities,
dsignificantly impact access to care
 Cultural diversity requires culturally competent care to
address needs of individual communities
Stories of Success in HIV: Summary
• Literature and experience demonstrate
strategies to improve HIV care in communities of
color
 Partner with other providers and AIDS service
organizations to improve linkage to care and provide
a range of necessary services
 Develop programs that meet the needs of local
patient populations