Talking HIVAIDS: Being prepared to serve persons living with HIV

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Talking HIV/AIDS Being prepared to serve persons
living with HIV

• DHS HIV/AIDS Unit
• Presenters
• Andy Ansell Rob Kacheroski

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Welcome

• Staff Introductions
• What does the HIV/AIDS Unit do?
• Program HH ADAP and Insurance Program
• Dental, nutrition and mental health benefits
• Case management and adherence services
• Support services through community organizations
• Information and referral

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Expectations for todays workshop

• How many of you have worked in the past or are
  currently working with persons living with HIV?
• Why did you choose to attend our session today?
• What do you want to get out of the session?
• How many of you would feel prepared to meet the
  needs of persons living with HIV?

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Learning Objectives

• What we will cover today
• Brief look at the current Minnesota Epi Data
• HIV Knowledge Building
• Preparing you to serve persons living with HIV
• Skills building scenarios
• Equip you with resources and referral information
  to help you serve your clients
• Increase your comfort level to effectively serve
  persons living with HIV

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Minnesota by the numbersAn overview of the
current epidemiological data
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U.S. State-Specific AIDS Rates per 100,000
PopulationYear 2007

HIV/AIDS in Minnesota Annual Review
SOURCEU.S. HIV/AIDS Surveillance Report,
Year-end 2007National Center for HIV, STD, and
TB Prevention, CDC
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Minnesota HIV/AIDS SurveillanceCumulative Cases

• As of December 31, 2008, a cumulative total of
  8,819 persons have been diagnosed and reported
  with HIV infection in Minnesota. Of these
• 3,471 persons have been diagnosed with HIV
  infection (non-AIDS)
• 5,348 have progressed to AIDS
• Of these 8,819 persons, 2,976 are known to be
  deceased

This number includes only persons who reported
Minnesota as their state of residence at the time
of their HIV and/or AIDS diagnosis.
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Estimated Number of PersonsLiving with HIV/AIDS
in Minnesota

• As of December 31, 2008, 6,220 persons are
  assumed alive and living in Minnesota with
  HIV/AIDS
• 3,415 living with HIV infection (non-AIDS)
• 2,805 living with AIDS
• This number includes 1,130 persons who were first
  reported with HIV or AIDS elsewhere and
  subsequently moved to Minnesota
• This number excludes 992 persons who were first
  reported with HIV or AIDS in Minnesota and
  subsequently moved out of the state

This number includes persons who reported
Minnesota as their current state of residence,
regardless of residence at time of diagnosis.
Includes state prisoners and refugees arriving
through the HIV Refugee Resettlement Program, as
well as, HIV refugee/immigrants arriving through
other programs.
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Living HIV/AIDS Cases by County of Residence, 2008
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Persons Living with HIV/AIDS in Minnesota by
Gender, 2008
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Persons Living with HIV/AIDS in Minnesotaby
Gender and Race/Ethnicity, 2008
African-born refers to Blacks who reported
an African country of birth African American
refers to all other Blacks. Other includes
persons with unknown or multiple races (n39).
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Number of Cases and Rates (per 100,000 persons)
of Persons Living with HIV/AIDS by
Race/Ethnicity Minnesota, 2008
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Persons Living with HIV/AIDS in Minnesotaby Age
Group, 2008
Age missing for 5 people .
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HIV 102 Building your HIV knowledge

• Understanding the difference between HIV and AIDS
• What happens when a person tests positive?
• Viral load and t-cell counts
• Genotype and Phenotype Testing
• Connection to Primary Medical Care
• Connection to support services

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HIV Treatment

• Anti-retroviral treatment
• When to initiate
• Combination Therapy
• How does it work
• Treatment adherence
• Access issues
• Prevention benefit

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Available Resources

• County Assistance Programs
• SSI or SSDI
• Minnesota Health Care Programs (Program HH,
  Minnesota Care, GAMC)
• MAP AIDS Line
• HIV Resource Guide
• Local AIDS Service Organizations

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Screening co-morbidities

• Many persons living with HIV have one or more
  co-morbidities
• Substance use
• Mental Illness
• Hepatitis C
• Recent release from incarceration
• Socio-economic status (homelessness, lack of
  insurance, lack of education, basic resources)

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Why can it be difficult to talk HIV?

• Primarily sexually transmitted
• Drugs and alcohol can be a contributing factor
• HIV/AIDS brings an immediate connection to
  mortality
• Fear, ignorance and misconceptions
• HIV disproportionately impacts minority
  communities

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Things to be sensitive of when working with
clients

• Newly diagnosed persons can be in shock
• Newly diagnosed individuals can have information
  overload
• Triaging most immediate needs is necessary
• Clients can be in denial
• Cultural differences exist that can create
  challenges in serving clients

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Sensitivity continued

• Where a client lives can greatly impact the
  services available and level of stigma
• Disclosure issues need to be addressed
• Protecting confidentiality is essential
• Maintaining sensitivity to clients emotional
  state
• Legal issues around immigration or discrimination

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Skills building Client Scenarios

• We will provide you with several client
  scenarios.
• Talk among your small group about how you would
  begin to meet the needs of the client.
• What challenges might you need to overcome when
  serving each client?

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Processing Questions

• What is the clients most immediate need?
• How would you triage this client?
• What are some of the barriers the client may have
  accessing service?
• What are some of the barriers or challenges you
  might have serving this client?
• Are there any issues you can see in this scenario
  you dont feel comfortable or equipped to handle?

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Client 1

• Mary is a Somali African Immigrant who lives in
  greater MN. She lives in a small community and
  is a part of a tight knit community of other
  Somali immigrants. Mary just tested positive and
  was referred to you for assistance. She has no
  health care coverage or connection to a clinic.
  She is frightened and doesnt want anyone in her
  community to find out this information.

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Client 2

• Marcus is a Hispanic male who lives in St Paul.
  Marcus is a recovering drug addict. Marcus found
  out he has HIV because of a trip to the emergency
  room where he was diagnosed with AIDS. Marcus
  was discharged from the hospital to find out that
  he was not allowed to return home because his
  family learned he has AIDS. He is homeless and
  has started using again.

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Client 3

• John is a 19 year old living in Minneapolis who
  tested positive at a local testing facility.
  John came out to his family when he was 15 and
  has been living on and off the streets ever
  since. He turned to sex work as a way to
  survive. He currently has a place to live but is
  terrified his roommates will find out his status.
  He has not health care or health care coverage.

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Client 4

• Beth has been living with HIV for 10 years. Due
  to her substance use, she has been in and out of
  substance use treatment and in and out of HIV
  care. She is currently not taking her HIV
  medication. Her health has deteriorated and she
  is now in danger of losing her job and apartment.
  She is clinically depressed and off of her
  anti-depressants.

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Reactions to client scenarios

• What insights did you have out of doing the
  exercise?
• What reactions did you have related to the life
  situations presented in the scenarios?
• What situations did you feel unprepared to deal
  with?
• What did you learn that could better prepare you
  to serve persons living with HIV?

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Closing

• Thanks for coming
• You can contact our program at 651.431.2414 or
  800.657.3761 or
• www.dhs.state.mn.us/hivaids