Transcript Barriers Implementing Prevention

DRAFT/BORRADOR (se traducirá al español una vez que se
apruebe la versión en inglés)
Barreras Para Implementar
Medidas de Prevención de la
Infección por el VIH
Barriers to Implementing HIV
Prevention
HIV/AIDS Prevention
PROJECT TIES
María Luisa Zúñiga, Ph.D.
University of California, San Diego
Saturday July 29, 2006
Workshop Goals:
1. To describe individual, provider and
structural/system barriers to preventing
transmission of HIV
2. To provide first-hand experience with patient
realities and needs through direct interaction with
patients
(Discussion with Persons living with HIV and Field
Trip to Las Memorias HIV Hospice )
3. To learn methods of overcoming barriers to HIV
prevention
Workshop Topics
1. Stigma and discrimination
2. Mexico’s health care system and its limitations
3. Examples of implementing prevention in settings
with limited resources
4. Opposition to harm reduction
5. Human rights and protection of human subjects
6. Role of systems: church, police, pharmacies,
jails/prisons
7. Understanding the Patient’s Perspective
8. Overcoming barriers to HIV prevention
Southern California Border HIV/AIDS Project
Service Delivery Model (SYHC)
COORDINATED CARE & SERVICES
PRIMARY CARE
INTERPRETATION
TRANSLATION
INTAKE
INTAKE
FOOD VOUCHERS
TREATMENT
EDUCATION
MENTAL HEALTH
DENTAL CARE
SPECIALTY CARE
SUPPORT & ART
THERAPY
GROUPS
LEGAL SERVICES
BENEFITS
COUNSELING
QUALITY OF LIFE
ASSESSMENT
VOLUNTEER
SERVICES
OUTREACH
TESTING & COUNSELING
ADAP
CASE MANAGEMENT
EARLY INTERVENTION
PROJECT EVALUATION
TRANSPORTATION
Southern CA Border HIV Project
Partner Clinic Sites
Vista Community Clinic
Clínicas de
Salud del
Pueblo
Family Health Centers
San Ysidro Health Center
“From an epidemiological
perspective, the border population
must be considered as one, rather
than different populations on two
sides of a border; pathogens do
not recognize the geopolitical
boundaries established by human
beings” (Weinberg M., et al., 2003)
Stigma and Discrimination Qualitative
study from the Southern California Border
HIV/AIDS Project
Qualitative Study with Male and
Female Latinas living with
HIV/AIDS
• concerns with seeking care at locations
where these women could be identified
and stigmatized by others
Qualitative Study with Male and
Female Latinas living with
HIV/AIDS
• Some women expressed dissatisfaction
with services for women because they
perceived that HIV/AIDS services are
geared toward homosexual men, namely
gay identified MSMs. This issue was
raised three times during the focus group.
Qualitative Study with Male and
Female Latinas living with
HIV/AIDS
• Many responses were linked to stigma and respondents
referred to a fear of being stigmatized by the surrounding
community,
– “What if they see you in a place where only infected people go,
then they’ll know you’re infected.”
– Participants mentioned that a lack of knowledge of HIV/AIDS in
the Latino community also affects them, “Within the Hispanic
community their not knowing anything about AIDS is worse…that
is they are still afraid that if you touch them, or if they drink from
your soda.”
– Fear of the participant’s families being stigmatized if anyone
knew of the participant's HIV status was also discussed.
Qualitative Study with Male and
Female Latinas living with
HIV/AIDS
• . Other responses included cultural issues
in reference to approaching physicians,
such as not voicing concerns because of
deference to doctors and the perception
that the doctor is always right.
Qualitative Study with Male and
Female Latinas living with
HIV/AIDS
Another barrier identified was not being able
to receive vitamins or medications for
secondary complications of HIV. One
participant mentioned that those without a
social security number face barriers in
accessing services.
Qualitative Study with Male and
Female Latinas living with
HIV/AIDS
One barrier to acceptability of services was
that instructions for prescriptions or some
informational brochures are written in
English: “I took the precaution of calling to
ask what it meant [a prescription], and
they told me it was for gargling…otherwise
I would have been drinking three doses [of
it], three times a day!”
2. Mexico’s health care system and
its limitations
Healthcare System in México
Dra. Adriana Carolina Vargas Ojeda
Universidad Autónoma de Baja California
March 2, 2006
31 states
1Federal District
2428 counties
•Covers an area of 1’964 375 sq.km
•Mexico shares a 3,152 km. border with the United
States to the north
•102 000 000 people (2002)
Health Care System in México
Historical and social aspects
 1943: Department of Public Health
Ministry of Health and Services (S.S.A.)
Mexican Social Security Institute (I.M.S.S.)
Children’s Hospital of Mexico (H.I.M.).
1960: Social Security and Services Institute for
Civil Servants (I.S.S.S.T.E.)
Mexican Healthcare System
Ministry of Health
S.S.A
Social Security
Mexican Social
Security Institute
Health Services
Security Institute
(IMSS)
(ISESALUD)
and Services Institute
for Civil Servants
(ISSSTE)
Zonal Hospital
County Medical Services
National Health Institutes
Peripheral clinics
Medical Services
For the Department of
Federal District
Military Hospital
Red Cross
Public Health Centers
Private Health Services
National Indigenes Institute
PEMEX
DIF
System
Financial
support
Social Security*
Federal
government Employers
l
(Fed taxes)
Employees
General health care**
Federal
Government
(General
Taxes)
Lowest fees
Only to recuperate
The spends.
Private
Recuperative
fees.
Variable
fees.
Others
PEMEX
Organization
Providers
Users
ISSSTE
IMSS
IMSS-Solidarity
Public Hospitals,
Public clinics and
MDs. under wages
Workers
Under wages
Beneficiaries
of the
insured
Retired
* Incluye IMSS, ISSSTE, PEMEX, SEDENA, SM
Health Ministry
Rural
Commu
nities
Free
Lance
workers
Prepaid
care
Private Hospitals
Private clinics
MD. fees
Public Hospitals,
Public clinics and
MDs. under wages
Low
Income
Popula
tion
Private insurance
Compensation
Self
Emplo
yees
** Incluye SSA, IMSS-Solidaridad
Open to all population
High income/low income
NETWORK SERVICES
TYPE OF UNITS
COMMUNITY HEALTH UNITS
HOSPITALS
Advanced centers for primaty heath care (CAAPS)
National Health Institutes
Mental health care centers
Regional Hospitals of high specialties
Centers for senior citizens
General Hospitals First and second level
Prenatal care centers
Community Hspitals
Centers for women suffering from domestic
violence
Mental Health Hospitals
Mental Health Rehab. Centers
Mobil units
House calls
SPECIALTIES UNITS
COMMUNITY SUPPORT UNITS
Imagenology
Advanced clinical lab.
Workshops
Dialisis
Shelters
Cancer
Short stay surgery
Emergencies
Shock and Trauma
AIDS
PUBLIC HEALTH UNITS
Rehabilitation
Public Health services Units
Public Health laboratories
Mexican Healthcare System
• Functions:
–
–
–
–
Health Services
Financing services
Management
Generator of human
resources
Challenges
1.
2.
3.
4.
5.
The demographic challenge
Geographic and social challenge
Epidemiological challenge
Scientific technologycal challenge
Medical schools and acreditation
DEMOGRAPHIC TRANSITION
2000
2050
0 – 15 years
Population
0 – 15 years
Population
33.5 millions
65 years or more
Population
4.7 millions
35 %
Decrease
591 %
Increase
21.7 millions
65 years or more
Population
27.8 millions
Mexican Healthcare System
Financement
• 5.6% of PIB(GDP) goes to health services
– (2.5% public)
– (3.1% private)
• States
uses only 3% of their budget
• 75% of IMSS budget is distributed in 2nd and
3rd. level
Mexican Health Care System
• Main Obstacles:
–
–
–
–
–
–
Inequity
Insufficiency
Inefficiency
Lack of quality
Un satisfaction
Insecurity
First ten causes of mortality in
15-24 years
•
•
•
•
•
•
•
•
•
•
Accidents
Injuries, homicides
Malignant tumors
Suicides
Heart disease
Pregnancy and postpartum problems
AIDS
Renal failure
Congenital malformations
Epilepsy
Mexican Health Care System
• We still have a lack of control or regulation in the
practicing of
–
–
–
–
–
–
–
Alternative medicine
Homeopathy
Acupuncture
Reflexology
Naturism
Iridology
Aromatherapy
3. Examples of implementing
prevention in settings with
limited resources
Tu No Me Conoces Social
Marketing Campaign to Promote
Risk Awareness and HIV Testing
in Latinos in the US-Mexico
Border Region
Campaign overview
• Cost
• Period of time
• Media used (radio spillover effects in
border region)
• Web site
• Results
• Lessons Learned
4. Opposition to harm reduction
What is harm reduction?
5. Human rights and protection of
human subjects
6. Role of systems: church, police,
pharmacies, jails/prisons, US Immigration
policy
• U.S. immigration policy on HIV varies by
type of immigration status, and for some
Mexican immigrants the threat of
deportation may prevent them from
seeking HIV testing or treatment for their
disease (American Foundation for AIDS
Research, 2001).
7. Understanding the Patient’s Perspective
(invite panel of persons living with
HIV/AIDS)
8. Additional strategies to address barriers to
HIV prevention
Quality of Services
Monitoring patient health
How up to date is patient contact
information?
Community-based work: involving
members of the target community
to reduce barriers to testing and
reducing high-risk behavior
• “El Cohete” Project