131st APHA Annual Meeting

November 15 – 19th, 2003

 

APHA Submission #58499

SPNS Initiative:

Four Corners American Indian Circle of Services (4CC)

 

 

 

 

 

Four Corners Circle of Services HIV/AIDS project on/near the Navajo Nation

Bonnie M. Duran, MPH, DrPH 1, Lorenda Joe, MPH 2, Kevin Foley, PhD 3, Melvin Harrison 4, Julie Lucero, MPH 2, Jon Iralu 5, Lynn Davidson-Stroh 5, Amy Peng 5, Dee Tsosie 4, Priscilla Weaneka 3, Maynard Shurley 4, Larry Foster 6, Ray Daw 3, Mae Gilene Begay 6, Curt Yazza 6, Daryl Joe 4. (1) Department of Family and Community Medicine, University of New Mexico School of Medicine, 2400 Tucker NE, #147, Albuquerque, NM 87131. (2) Family and Community Medicine, University of New Mexico School of Medicine, 2400 Tucker NE #145, Albuquerque, NM 87131. (3) The Na'Nizhoozhi Center, 2205 East Boyd, Gallup, NM 87301. (4) Navajo AIDS Network, 207 South Second Street, Suite B, Gallup, NM 87301. (5) Gallup Indian Medical Center (GIMC), 516 East Nizhoni Blvd., Gallup, NM 87301. (6) Division of Health, Navajo Nation, PO Box 1390, Wind Rock, AZ 86515.

“Integrating HIV, Substance Abuse and Mental Health Services on the Navajo Nation” is a project of the Four Corners American Indian Circle of Services Collaborative (4CC): the Na’Nizhoozhi Center (NCI); offices of the Navajo Nation Division of Health (a) Research and Evaluation (b) Social Hygiene (c) Communicable Disease, (d) Behavioral Health; and the Navajo Area Indian Health Service (NAIHS); the Navajo AIDS Network (NAN) and faculty, staff and students from the MPH program at the University of New Mexico. The project’s goals are to (1) enhance substance abuse and mental health services for AI people with HIV/AIDS on or near the Navajo Nation; (2) screen persons at risk for HIV/AIDS, and (3) to reduce new HIV infection in the community. The methods to accomplish these goals are two fold. First, using Systems Theory methods, mental health, substance abuse and medical services from multiple sources will be integrated. Second, using Motivational Interviewing (MI) techniques, treatment providers (physicians, pharmacists, case managers, mental health staff, substance abuse counselors) will motivate clients to (a) enter needed substance abuse and mental health services (b) improve treatment adherence (c) reduce HIV/AIDS risk behaviors. Motivational Interviewing, a culturally appropriate theory for use with AI clients, is: 1) Client centered, 2) Non-directive, 3) Respectful of the client's strengths and knowledge about what is best for themselves, 4) Empathetic, 5) Not interested in labels such as "addict" or "alcoholic", 6) Not interested in confrontation as a style of interviewing, and 7) Mindful of client choice and preference. See www.ou.edu/hiv/ 


 

 

APHA Submission #57379

SPNS Initiative:

Yukon-Kuskokwim Health Corporation

Developing an HIV testing model for Alaska Natives in rural Alaska

Mark A. Anaruk, MEd, Yukon Kuskokwim Health Corporation, PO Box 528, Bethel, AK 99559

Funded by the HRSA, SPNS grants, the purpose of this project is to design, implement and evaluate a community-based service delivery model in western Alaska that addresses 1)the challenges associated with delivering services to Alaska Natives, 2) the cultural differences that exist with the Alaska Native population in comparison to the dominant culture, and 3)issues that hinder the success of HIV testing methods among Alaska Natives in southwestern Alaska. A thorough literature search on HIV testing methods for rural Alaska Natives turns up little or no relevant information. The primary purpose of this initiative is to reverse this void and document a culturally appropriate HIV testing method that may be used in furthering HIV testing and surveillance of Alaska Natives throughout rural Alaska, and thereby increasing the number of Alaska Native individuals who know their HIV status. This presentation describes the service delivery model developed and the planned implementation and evaluation process. See www.ykhc.org


 

 

 

APHA Submission #58440

SPNS Initiative:

Native American Health Center/Friendship House

Behavior, lifestyle and social determinants of health

Karen Elizabeth Saylors, PhD, Native American Health Center, 160 Capp Street, San Francisco, CA 94601

The main objective of the HRSA Special Projects of National Significance (SPNS) initiative is the culturally competent coordination of HIV care for our Native American clients. This care coordination includes HIV primary care, HIV dental care, mental health care, cultural interventions, outreach case findings, and substance abuse services, coordinated through holistic case management. Client care ranges from being exclusively in-house, which requires interdepartmental care coordination, to a combination of in-house and external care, which requires intensive referral tracking and case management. The Holistic Native Network is a collaboration of two major Native American organizations in the San Francisco Bay area: the Native American Health Center (NAHC) and the Friendship House Association of American Indians (FH). These agencies have organized a comprehensive, holistic, and integrated system of care for Native Americans suffering from substance abuse, mental health issues, and HIV/AIDS. Through health education and referral from the Friendship House to the Native American Health Center’s HIV Testing & Counseling Program, high-risk clients at Friendship House treatment program will become aware of their HIV status. During the health educations sessions, a pre- and post-HIV knowledge test are administered to evaluate clients increasing their knowledge of HIV transmission. This presentation will focus on client level change, as measured by initial outcome measures, and program implementation across the two service organizations. See www.ou.edu/hiv/


 

 

 

APHA Submission #56737

SPNS Initiative:

South Puget Intertribal Planning Agency

Outreach to HIV-infected American Indians: The South Puget Intertribal Planning Agency experience

Jennifer R. Olson, MPH, South Puget Intertribal Planning Agency, 122 S. 3rd Street, Shelton, WA 98584 and Karina K. Uldall, MD, MPH, School of Medicine, University of Washington, 901 Boren Avenue, Suite 900, Seattle, WA 98104

The purpose of this presentation is to provide information on the South Puget Intertribal Planning Agency HIV-outreach project, targeting members of the Nisqually, Squaxin Island and Shoalwater Bay tribes in Washington State. Funded under the Health Resources and Services Administration HIV/AIDS Bureau Special Projects of National Significance, the goal of the project are to increase the number of American Indians that know their HIV status, particularly those at increased risk due to substance use and mental illness and to increase the number of HIV-positive American Indians who receive comprehensive and culturally relevant primary care. Specific objectives include reduction of HIV/AIDS stigma, increased awareness of HIV risk factors, increased HIV testing and counseling, and ultimately, identification of HIV-infected individuals and linkage to primary care services. The outreach and linkage model will be presented. Initial evaluation results will be discussed. See www.ou.edu/hiv/


 

 

 

APHA Submission #57330

SPNS Initiative:

Alaska Native Tribal Health Consortium (Anchorage)

Barriers and facilitators to developing a partnership between corrections and Alaska Native health entities

Tracy Speier, BA, Special Project of National Significance, Alaska Native Tribal Health Consortium, Office of Community Health, Division of HIV/AIDS, 4201 Ambassador Dr., Anchorage, AK 99508 and Gloria D. Eldridge, PhD, University of Alaska, Anchorage, Alaska Comprehensive and Specialized Evaluation Services, PO Box 241626, Anchorage, AK 99524-1626

In Alaska, correctional systems house a disproportionate number of Alaska Natives with, or at risk for, HIV/AIDS, hepatitis, STD’s, substance abuse and mental illness. As of December 31, 2000, 36% of individuals in the custody of the Alaska State Department of Corrections were Alaska Natives while comprising only 15.6% of the total Alaskan population (Department of Corrections, Administrative Services, 2000 Offender Profile; U.S Census, 2000). Because the majority of incarcerated individuals are eventually released, undetected or untreated infections are transmitted back into the community. Funded under the HRSA, SPNS initiatives, the Alaska Native Tribal Health Consortium and the Alaska Department of Corrections entered into a collaborative partnership to address this issue. The outcome of this partnership was a model that will guide the collaborative development and implementation of a transitional comprehensive health screening and treatment referral program for Alaska Natives being released from prisons and jails. This presentation describes the barriers and facilitators to collaboration between the Department of Corrections and Alaska Native health entities, the model developed, and the planned implementation and evaluation process. See www.ou.edu/hiv/


 

APHA Submission #57960

SPNS Initiative:

Robeson Health Care Corporation

Improving the health status of American Indians through building community capacity: “The Healing Lodge” experience

Millard Lowry, MA(Dual), Native American Interfaith Ministries, Inc. (Healing Lodge), 450 Prospect Rd., PO Box 1695, Pembroke, NC 28372 and Rev. Jo Lentz, M DIV, Partners In Caring, Duke University Medical Center, 1806 Bryn Mawr Dr., Fayetteville, NC 28304

The Native American Interfaith Ministries, Inc (“The Healing Lodge”) is a non-profit faith-based ecumenical organization that partnered with Robeson Health Care Corporation to work with the Southeastern North Carolina American Indian HIV/AIDS Initiative. Funded under the HRSA, SPNS initiative, the purpose of this project is to develop and establish empowered culturally appropriate services to American Indians residing in or adjacent to Robeson County who have or are at high risk of having HIV/AIDS and co-morbidities. The American Indian population is predominantly members of the Lumbee Tribe, state recognized but not federally and therefore does not qualify for the health benefits provided through Indian Health Services. The lack of federal recognition creates additional barriers to building community capacity to service American Indians who are at high risk for acquiring HIV/AIDS. This presentation will illustrate an intervention model developed to 1) increase the capacity of the community to focus on HIV/AIDS prevention and intervention; 2) increase the number of culturally appropriate HIV/AIDS prevention services provided by the “Healing Lodge”; 3) improve the ability of the faith community to provide culturally competent HIV prevention and intervention services; 4) increase the amount of HIV testing in places where American Indians may access services; 5) improve the infrastructure of HIV/AIDS services in the community; and 6) decrease the time elapsed between a positive test and the receipt of HIV/AIDS services. See www.ou.edu/hiv/


 

APHA Submission #62582

SPNS Initiative:

University of Oklahoma, Research & Evaluation Center

Social, cultural and geographical issues that affect implementation of HIV/AIDS services for American Indians and Alaska Natives

David D. Barney, MSW, MPH, PhD, School of Social Work, University of Oklahoma, 1005 S. Jenkins Avenue, #203, Rhyne Hall, Norman, OK 73019 and Betty E.S. Duran, MSW, MPH, School of Social Work, University of Oklahoma, 1005 S. Jenkins Avenue, #203, Rhyne Hall, Norman, OK 73019

The DHHD - Health Resources and Services Administration, Special Projects of National Significance funded six HIV/AIDS demonstration projects to develop unique models of care for American Indians and Alaska Natives. The presenter will 1) identify the social, cultural and geographical issues that affect the delivery of medical care and services to American Indian and Alaska Native, 2) discuss the complexity in coordination of care for a population comprised of multiple tribal groups, all of which have distinct languages and beliefs that affect the individual's response to services, and 3) identify special issues that will assist public health professions in better understanding the needs of this population. See www.ou.edu/hiv/


 

 

APHA Submission #62856

SPNS Initiative:

University of Oklahoma, Research & Evaluation Center

Alaska Native Tribal Health Consortium

Traditional culture, subsistence living and the threat of HIV/AIDS

David D. Barney, MSW, MPH, PhD, School of Social Work, University of Oklahoma, 1005 S. Jenkins Avenue, #203, Rhyne Hall, Norman, OK 73019 and Tracy Speier, BA, Special Project of National Significance, Alaska Native Tribal Health Consortium, Office of Community Health, Division of HIV/AIDS, 4201 Ambassador Dr., Anchorage, AK 99508

In Alaska, a significant segment of the Alaska Native population continues to reside in geographically isolated rural villages and communities that retain their traditional customs, language, and hunting and fishing practices as a way of life. These communities strive to combine the ‘old ways’ with more recent Western technology, religions and formal education. In part due to unique geographic and climatic factors, it is not surprising that rural, isolated Alaska Native villages had been fairly insulated from the medical, social and economic implications of HIV/AIDS. However, in recent years it has become a major health issue in rural isolated Alaska Native villages. To identify issues related to a Native village response to HIV/AIDS, a qualitative study of 30 key informant interviews was conducted throughout two rural, isolated Native villages. These interviews were conducted in homes, village clinics, and community centers with a diverse sampling of individuals who were affected by HIV/AIDS; including village chiefs, elders, adolescents, health workers and family members. The presenter will discuss 1) the range of responses to learning that other village members were HIV infected, 2) the impact of HIV related deaths, and 3) how community members and the community as a whole addressed the first appearance of HIV in their villages. See www.ou.edu/hiv/