After 30 years of battling the virus that causes AIDS, tactics to end the epidemic have become strategic and varied. From bus ads and billboards, to online campaigns and commercials, to the first-ever National HIV Strategy, the fight for an AIDS-free generation is officially on.
Efforts on the ground have met with success as the number of deaths due to AIDS-related causes has given way to people living longer with HIV. Despite the turnaround, many on the front line have sought ways to access communities that may be at higher risk for contracting HIV, particularly in the immigrant populations who may not see themselves as the target of HIV messages.
In an effort to help health care workers make inroads into the immigrant population, the Office of Minority Health Resource Center's National African Immigrant Project [NAIP] uses training seminars to educate health care workers on better meeting the needs of African immigrants around the topics of HIV/AIDS and reproductive health. With a focus on cultural competency, each training seminar gives providers and community workers insights into cultural practices and beliefs to enhance the care African immigrants receive in the health care setting.
Valerie Bampoe, an HIV health educator for Inova Juniper Program and an immigrant from Ghana, helped organize such an event in June just outside of Washington, D.C., hitting the max of 75 attendees almost a month in advance. The NAIP training, "Breaking the Glass," was a daylong seminar, highlighting the cultural nuances that are needed to navigate topics of sexual health and HIV stigma with African immigrant patients in order to better meet health needs.
Culturally competent trainings are a key component of the NAIP, which for the last four years has championed the training of physicians and community organizations who work with Africans to become aware of cultural differences in order to more effectively deliver prevention information to their clients and make a significant dent in HIV/AIDS rates in Washington, D.C. and elsewhere. The program addresses issues such as stigma associated with HIV testing and status, culturally sensitive ways to discuss sexual health and HIV transmission, as well as the importance of prevention and early disease detection.
Bampoe said it is the cultural under-girding that is needed to make inroads into the community and save lives. "There are so many things that are different, so many different components about how we grew up and what we're exposed to that impact the way we do things."
"When you have no exposure, no training, you're probably going to do all the things you shouldn't do and cause [your patient] not to come back," Bampoe said. "It helps for providers to be aware of the various things that could be impacting a person's life."
Instead, cultural competency takes into account the factors that impact a person's life, like race, language, beliefs and practices and country of origin and then uses that knowledge to help tailor delivery of care, with the goal of providing a quality health care experience.
"Cultural competency is key," Bampoe said. "I worked in an emergency room for three years and even more so in that setting you need to be in tune with everything in order to make an accurate diagnosis and save lives. In the non-critical setting it's still key, but they're going to need a lifetime of care, because HIV is a chronic disease."
Providers have turned more to culturally competent care as the nation has become increasingly diverse. It is estimated that by the year 2050, minorities will become the majority in the U.S., with some anticipating an earlier shift by 2042.
As one of the fastest growing immigrant groups, the African population in the U.S. has grown steadily since the 1960s. According to the 2009 American Community Survey, the African immigrant population in the U.S. was about 1.5 million people with nearly 10 percent residing in the District.
For African immigrants, receiving culturally competent health care is especially critical in a place like Washington, D.C, where HIV/AIDS affects 3.2 percent of adults and adolescence.
To help providers reach African immigrants who may be at increased risk or living with HIV, the training covered the impact of gender roles in a male-dominated society, deeply held views on sexuality and the human body, continuity of traditions, such as female circumcision, the role extended family plays in marital relationships and how religious beliefs and views of doctors and the health care system impact when and if someone even goes to the doctor.
The desire to better reach African immigrants led Robyn Harris to attend the June training. A community health worker for the International Rescue Committee, Harris found herself struck by the oppression some women encounter and became even more sensitive to what the immigrant women she works with may or may not be saying.
"It's something we need more of," Harris said. "A second training on this exact topic would be great because I'm sure there are a lot of things we didn't go over ... A mental health aspect to this training [would be great]."
Combined with these issues is an unwillingness to talk about sex, stigma surrounding HIV and the elimination of HIV testing as part of the immigration process, which led training attendees to voice the realization that culturally competent efforts will need to drastically increase.
Like all new subjects, it will take time before providers can navigate the cultural terrain, according to Dr. Emmanuel Koku, interim director of Africana Studies at Drexel University and one of the training presenters. But he stresses the importance of becoming knowledgeable and remaining hopeful.
"We want providers to be culturally proficient," Koku said. "To be able to prevent HIV within different cultures you need to be very much aware of the needs and values of the client."
The NAIP is a federally-funded project of the Office of Minority Health Resource Center. To learn more about the NAIP, or for more information on the training curriculum please dial 800-444-6472 or visit minorityhealth.hhs.gov.