Culture, Cultural Competency, Sensitivity, Awareness and other Issues Concerning Latinos Living with

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Training Providers Who Serve Mono/Bilingual
Spanish-Speaking Clients
Tom Donohoe, MBA Octavio Vallejo, MD, MPH
UCLA Pacific AIDS Education and Training Center
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(No Transcript)
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People living with HIV in the USA. 2003
Infected without Knowing their HIV
Status 180-280K Knowing their HIV In medical
care With AIDS diagnosis
230,000 200,000 130,000 340,000
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Minorities of Color and HIV

• Three of every five new AIDS cases in men were
  among minorities (63.8 percent)
• Four of every five new AIDS cases in women were
  among minorities (81.9 percent)
• Four of every five new AIDS cases in children
  were among minorities (85.6 percent)

Ryan White Comprehensive AIDS Resource Emergency
(CARE) Act. 2002
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LATINOS What have we learned?

• The percentage of new AIDS cases among Latino/as
  has increased in the last 15 years
• In California Latino/as are the 30.8 of the
  total population yet now account for 34.9 of the
  AIDS cases.
• Latino/as receive an AIDS diagnosis at early ages
  (lt 30 year-old)
• HIV transmission occurs more frequently among
  (MSMs and women for heterosexual contact).

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Latinos and HIV

• Increase in number of new infections
• Increase in number of Latinos/as newly diagnosed
  with AIDS
• Too late detection of HIV status
• Late access to health care
• Misperceptions and ignorance about the U.S.
  health care system
• Language barriers

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Latinos and HIV

• Translators
• Translations often conducted by office staff and
  family, including children
• Even professional translators report difficulty
  translating technical, medical, and personal
  (sexual, drug/physical abuse) information
• Translators need training too!

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Culture and HIV
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Culture and HIV Introduction

• Culture as a body of learned behaviors common to
  a given human society, acts rather like a
  template, shaping behavior and consciousness
  within a human society from generation to
  generation
• - Systems of meaning (language)
• - Ways of organizing society

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Culture involves at least 3 components

• What people think
• What they do
• Material products they produce.
• Thus mental processes, beliefs, knowledge, and
  values are parts of culture.
• Mental rules guiding behaviors (according to
  some anthropologists)

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We would like to..

• Increase awareness of cultural competence
• Understand the elements of cultural competence in
  health care
• Apply cultural competence mindset to your
  job/responsibilities

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Cultural Competency in the Health Care Setting

• Set of attitudes, skills, behaviors, policies
• Enables organizations and individuals to work
  effectively cross-culturally
• Understands importance of health-related
• beliefs, attitudes, and practices
• communication patterns of beneficiaries
• Eliminates disparities in health status

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When we say that a health care setting is
cultural competent ?

• When this setting has demonstrated awareness and
  integration of three population specific issues
• health-related beliefs and cultural values
• disease incidence and prevalence
• treatment efficacy

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Organizational Cultural CompetenceA journey, not
a destination...
Unaware, Competent
Aware, Competent
Aware, Incompetent
Unaware, Incompetent
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Cultural Competence

• Awareness and acceptance of differences
• Awareness of owns cultural values
• Awareness of dynamics of differences
• Development of cultural knowledge
• Ability to work within others cultural context
• Healthy self-concept
• Free from ethnocentric judgment

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The AWARE ModelCommunication Across Cultures

• Accept the other persons behavior without
  judging it based on what that behavior means in
  your culture

• Wonder what the persons behavior means in
  his/her culture, rather than what it means in
  your culture
• Ask what it means to
• the person, showing a respectful interest

Noel Day, Polaris Research Development
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The AWARE ModelCommunication Across Cultures

• Research and read about other persons culture so
  you are able to place their behavior in the
  context of their cultural word view

• Explain what the behavior means in your culture.
  Demonstrate and or describe the behaviors in your
  culture that would express similar feelings or
  meanings

Noel Day, Polaris Research Development
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Latinos and the US Health Care System

• The concept of developing relationships with
  medical providers and becoming part of the team
  care is a foreign concept
• First of all, it is necessary to encourage
  patients to educate themselves about all his/her
  options, how to express their opinions, concerns,
  doubts and disagreements

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Latinos and HIVTreatment services must take
account

• Latinos appreciate mutual respect in social
  relationships, especially with authority figures.
  They strive to preserve personal integrity in
  interactions with others. A person receiving
  medical or drug treatment must feel that he or
  she is treated with respect and valued, or
  treatment will be rejected.

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Latinos and HIVTreatment services must take
account

• Latinos have a different perception of time, with
  a more flexible understanding of punctuality.
• Saving time is seen as less important than
  smooth, warm social relationships. A Latino
  patient may see as rudeness a hurried pace or
  focus on saving time on the part of a caregiver.

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Latinos and HIVTreatment services must take
account

• Familismo.- Emphasis on the family as the primary
  social unit and source of support. Strong ties
  within Latino families.
• Simpatia.- The importance in the culture of
  polite and cordial social relations. (central
  cultural value and social expectation).Shuns
  assertiveness, direct negative responses and
  criticism. Como Usted diga

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Latinos and HIVTreatment services must take
account

• Personalismo.- Latino preference for
  relationships with others that reflect a certain
  familiarity and warmth. Latino may be more likely
  to trust and collaborate with someone with whom
  they had pleasant conversations. We need a
  friend and support in the fight against this
  disease. Sometimes the providers are extremely
  cold and professional.