HIV/AIDS Work Group on Health Care Access Issues for Hispanic Americans

36 Pages·1991·1.7 MB·English

by  U.S. Department of Health and Human Services, Public Health Service, Health Resources and Services Administration

WORK
GROUP
ON
HEALTH CARE
ACCESS ISSUES
for Hispanic Americans
Health
Office of Minority
Resource Center
PO Box 37337
DC 20013-7337
Washington,
WORKGROUP#2
ACCESSTORYANWHITESERVICES
BYHISPANICAMERICANS
December15-16, 1991
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P
U.S.DEPARTMENTOFHEALTH&HUMANSERVICE
PublicHealthService
HealthResourcesandServicesAdministration
BureauofHealthServicesDevelopment
DHHSPublicationNo.HRSARD-SP-93-8

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WORK GROUP
ON
HEALTH CARE
ACCESS ISSUES
for Hispanic Americans
WORKGROUP#2
ACCESSTO RYAN WHITE SERVICES
BYHISPANICAMERICANS
December 15- 16, 1991
SfcRVlCEs
U.S.DEPARTMENTOFHEALTH&HUMANSERVICE
PublicHealthService
HealthResourcesandServicesAdministration
BureauolHealthServicesDevelopment
DHHSPublicationNo.HRSARD-SP-93-8

TABLE OF CONTENTS
OVERVIEW
I. 5
BACKGROUND
II. 9
III. ACCESS ISSUES DISCUSSED 11
IV. HIV/AIDS IN PUERTO RICO 16
V. CULTURAL VALUES AND BELIEFS 17
VI. HEALTH CARE PROVIDERS 21
VII. RECOMMENDED EVALUATION STUDIES ...25
VIII. APPENDICES 29
Bibliography
Work Group Meeting Agenda
ParticipantList

OVERVIEW
I.
When the Congress ofthe United States enacted the
RyanWhite Comprehensive Resources Emergency (CARE)
Actin 1990, the stated objectivewas
"...to provide grants to improve the quality and avail-
ability ofcareforindividuals and families with HIV dis-
ease../'
The RyanWhite programs make valuable services
available tomanypeople withHIV andAIDS. But availabil-
ity ofservices doesnotnecessarilymean thatthepeople for
whomservices were designed are able to obtain access to
them.
TheHealthResources and Services Administration's
Bureau ofHealth Resources Development (BHRD) adminis-
ters Titles I and II oftheRyanWhite CARE Act. Part of
BHRD's managementconcern relates to thebarriers which
maylimit orpreventunderservedpopulations from seeking
access to availableHIV/AIDS services.
In an efforttobetterunderstand thebarriers thatinhibit
or, insome cases, prohibitthese populations fromseeking
access to HIVservices, BHRD convened a series ofwork
group meetingsbeginninglate in 1991. The goal ofeach
workgroup meeting is tounderstandmore about the real
and perceivedbarriers facedby the under served popula-
tions inneed ofHIV/AIDS services. Based onworkgroup
recommendatinos, BHRDwill develop evaluationprojects
that lookatways to improve the accessibility ofHIV/AIDS
services for the particularpopulation. Technical assistance
plans will alsobe developed tohelp States and cities imple-
menteffective program solutions. The results ofthe evalua-
tionprojects willprovide an enhanced understanding of:
• whycaremaynotbe available to some populations
• whycareisnotsought or isnot accessible whenitis
available, and
• what steps need tobe taken to remove thebarriers
which limit or prohibitunderserved populations from
seeking services from Ryan White CARE funded pro-
grams.
Eachworkgroup hasbetween 10 and 20invited partici-
pants who are members ofanethnic orminority group.
Participants include serviceproviders, people livingwith
AIDS, and health services researchers, some ofwhom are
involvedin the implementation ofthe CARE Act. Work
group sessions are moderatedby Federal staff.
The setting and format are informal to allow forcreative
thinkingand in-depth discussion. The objective ofthe work
group meetings is to assist BHRD in defining and under-
standing the complexity ofissues which influence a person's
perception aboutwhether a service is accessible to them or
not, and:
• to develop priorities forevaluationresearch and techni-
cal assistance onbarriers to access, includingtopics,
methods and designs;_to compile abibliography on
barriers to HIV/AIDScare and relatedhealth services
research;
• to identifyhealth services researchers working onHIV/
AIDS related topics;
• to identifymembers ofthe affected populationwho
directly deliverhealth care and support services and
would serve as consultants tohelp identify issues of
highestpriority for evaluation and follow-up.
Areas fordiscussion included, butwere not limited to:
• thebarriers to access that arebased on real orperceived
patterns ofdiscrimination;
• thepatterns ofreferral, includinglay referrals, self-
treatmentwith "traditional/folk" remedies, "experimen-
tal" drugs, and reasons for choosing services/providers;
• the previous experience ofpeople inneed ofcare as a
factor in their attitude aboutseekingcare;
• the attitude and staffing ofthe provider agencies; _the
organization and coordination ofthe many services and
agencies a clientuses, including CARE ActTitle I
planningcouncils and Title II consortia.
• the individual decision-makingprocesses, including the
medical, psycho-social, familial, and organizational
factors.
The focus ofgroup discussions is on describing the
difficulties in accessinghealth care faced by individuals with
HIV fromparticularpopulations, such as women or patients
with ethnic, racial, economic orculturalbackgrounds that
differfrom thepopulationusually servedby the agencies
providing HIV services.
The goal is tomodify the delivery system to make sure
thatRyanWhite services are easily accessibleby patients for
whom
the services are intended.
Atleastsevenwork groups on access to HIV services
havebeenheld or are planned through 1993 as follows:
WorkGroup # 1 - AfricanAmericans
WorkGroup #2 - Hispanic Americans
WorkGroup #3 - Women
WorkGroup #4 - Native American Indians
WorkGroup #5 - AsianAmericans
WorkGroup #6 - GayMen (including gaymen of
color)
WorkGroup # 7- EvaluationPriorities and Strategies
WorkGroup meeting#2 focused on access to Ryan
White servicesbyHispanic Americans. BHRD invited
Hispanic service deliveryprofessionals andhealth services
researchers withexperienceworkingin andwith Hispanic
communities, andpeople livingwithHIVto identify the
barriers limitingHispanic Americans from obtaining access
to andparticipatinginRyanWhite HIVservices. A Partici-
pants Listis included intheAppendix.
The work group met on December 15-16, 1991 and was
moderatedby BHRDstaffmembers Eda Valero-Figueira,
Ph.D., Senior Public HealthAnalyst, Division ofHIV
Services, and Moses B. Pounds, Ph.D., a Senior StaffFellow,
Office ofScience and Epidemiology. The workgroup's
recommendations willbe distributed for review andcom-
ment to the Title I and IICARE Act grantees and among the
workgroup participantsprior to the development ofa final
evaluation agenda. We view these work group meetings as
thebeginningofa learning and collaborativeprocess among
HRSA, its grantees, and the peoplewith HIV disease.
The purpose ofthefollowing summary is to present the
views ofthe workgroup members on the problemsfaced by
Hispanic Americans in gettingand maintainingaccess to
HIV/AIDS services. Theformat ofthe meeting encouraged
participants to discuss access issues andformulate evalua-
tion and technical assistance questions which could be
addressed by BHRD. This is a summary ofthe access issues
discussed andprogram evaluation projects proposed by the
workgroup participants over one-and-a-halfdays.