A. Focused Discussions

Three main themes repeatedly emerged across the multiple discussion groups that described participants’ perceptions of key provider needs to enhance provision of state-of-the-art HIV care for African-American patients. Those themes were: increase cultural competence, increase access to financial linkages, and increase access to comprehensive care services. Participants articulated that NMAETC training priorities should include educational components to strengthen providers’ abilities to address these thematic concerns.

Cultural Competence

Discussion participants stated that minority patients continue to distrust health care providers, particularly providers who lack cultural competence and practice in a culturally insensitive manner.
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In expounding, they reported that provider cultural insensitivity has subtle manifestations, such as withholding disease-related explanations from patients whom they perceive to be less educated or of low-income. Further, they explained that many low-income patients struggle with unique socio-economic barriers to care. Their daily economic needs are often urgencies that compete with managing their HIV/AIDS.

Participants cited a need for providers to become more culturally competent and sensitive to the complex situational barriers facing low-income, minority patients.

It was expressed that greater cultural competence would lead to enhanced patient teaching and communications skills that would more effectively address patients’ issues around prevention, treatment options and adherence barriers. Further, the lack of cultural competence among providers may have another indirect impact on minority patients’ poor clinical outcomes.

In search of culturally competent providers, it was asserted that many minority HIV-infected patients choose a provider that is culturally and linguistically similar to themselves, even though sufficient numbers of minority HIV specialty providers are lacking. This often leads to patients seeking care from primary care providers who may lack expertise in up-to-date HIV clinical management. Primary care providers tend to see few HIV-infected patients annually and thus do not maintain the clinical expertise needed to manage complex emerging therapies and HIV/AIDS complications. As a result, their HIV-infected patients may not receive the quality of care needed for optimal clinical outcomes.

Financial Reimbursement

In relation to the lack of minority HIV specialists, participants stressed that the few minority HIV specialists are overtaxed with a disproportionate amount of under-insured and uninsured patients who often present in late stages of disease. It was expressed that more minority providers would become involved in HIV specialty care if they were more aware of linkages to third-party funding that would reimburse them for the financial burden incurred by caring for low-income, HIV-infected patients. Additionally, it was discussed that HIV specialty care would be more attractive if higher salaries were offered for willingness to accept the perceived risk of working with HIV-infected populations and stay abreast of the rapidly changing complexities of state-of-the art HIV clinical care.

Comprehensive Care

Participants noted that many infected individuals meet their HIV diagnosis with feelings of denial, shame, fear, and anger. Negative emotive responses to HIV often override the patients’ desire to thrive and serve as a barrier to care seeking and treatment adherence. Also, large numbers of HIV-infected substance users may require comprehensive medical, psychological and economic support to mitigate their addiction-related barriers to HIV treatment adherence. canadian antibiotics

Thus, it was believed that psycho-socio-economic issues often converge as factors that negatively impact clinical outcomes in minority, low-income and hard to reach populations. Participants further believed that clinical providers are unable to manage these patient care issues without the partnership of non-clinical providers. HIV-infected patients need access to other specialty medical services such as dental, cardiology, ophthalmology, psychiatry, etc Yet, it appeared to them that clinical providers often lack information about the availability of comprehensive care services and knowledge of referral procedures to achieve more integrated medical care and access social support services for their HIV-infected patients.

B. Medical Care Service Sites’ Survey

All medical care service sites expressed having some access to each of the health services support categories covered in the survey. However, they also reported that they could benefit from increased support in each category (Table 1). Based on percentage of sites that responded “definitely yes” or “probably yes” to survey items that assessed perceptions  of     increased training and support  needs,  the highest indications were in the following areas:   1)   how to secure funding to care for underserved minority clients HIV-percent), 2) obtaining better access to the  necessary specialty referrals for HIV- infected clients ,percent) and  hearing about ways to make their services more comfortable and accessible for minority ethnic clients (64 percent). Many (61 percent) primary care medical service sites also reported a need for further training in HIV therapy and therapy adherence issues. viagra soft