Originally Broadcast: Friday, September 25, 2020 from 12:30 PM - 1:30 PM EDT
Confronted by the triple challenges of HIV, COVID-19, and systemic racism, Black communities are experiencing ongoing disparities in health outcomes. The program will explore how advances in the HIV landscape may address obstacles and help bring an end to the HIV epidemic. It will also look at current challenges, how they impact HIV care, and how increased use of disruptive innovations such as telehealth platforms may help improve and fast-track HIV care and prevention strategies. Through conversations, the program will also seek to show not only how far we as a nation have come in terms of grappling with the HIV epidemic, but also how far we still need to go. Stigma, discrimination, and bias continue to hamper our efforts to bring all patients into our care. Overcoming this entails a commitment to self-reflection and to creative strategies to increase uptake in HIV care and prevention.
Learning Objectives
Describe the intersectionality between COVID-19, HIV, and health disparities
Understand the potential role of disruptive innovations, such as telehealth, for supporting HIV treatment and prevention
Highlight advances in the HIV landscape
Good day, everyone. My name is Beth Sheba Johnson, senior director for HIV prevention Western United States at Gilead Sciences. Welcome to our program today. I would like Thio first, acknowledge a little housekeeping. This is not a C EU program, so there will be no code. In addition to that, there's a button below your screen so that you could submit questions. I think that I'd like to begin by thanking you, the leadership organizers and the participants of the National Association of Black Nurses for inviting us to conduct this panel discussion at the 48th Annual Inaugural Virtual Conference and the Year of the Nurse, which in my humble opinion, is every year I would like to begin by introducing our August Panelist for this session, beginning with Deb Wafer. Deborah is currently working at Gilead Sciences as an HIV prevention medical scientists, where she provides education toe healthcare providers on post exposure prophylaxis or pep, pre exposure prophylaxis or prep and other predict prevention modalities. Deborah has also worked at the Gilead HIV and HCV community marking teams and is an accomplished marketing professional and demonstrated experience in developing innovative programming and tools designed to engage healthcare providers, staff and communities. Next we have Dr Rashida Chandler. Dr. Chandler is the director of Queen Bee and I love That Name, which stands for Quality, Equitable and Elektronik Interventions for Black Women Lab. She's an academician and family nurse practitioner. She currently works at the Nell Hudson Would Drift School of Nursing at Emory University. Dr. Chandler's research focuses on sexual and reproductive health, with an emphasis on HIV prevention using tough technological methods, such his APs and telemedicine for black women. You may remember her from last year's N B a n B in a program. And then finally, we have the newly minted Dr Tobel Kendo. Dr. Kendall is a board certified family nurse practitioner. He currently works at ST Thomas Community Health Center in New Orleans, where he provides primary and specialty care and education and prevention services to adolescents and adults at risk for and living with a wide array of infectious diseases. He completed the R and an A P. R N programs at Grambling State University, the DNP degree at the University of South Alabama College of Nursing and the PhD. As I said he was newly meant adjust in August in nursing education at the William Carey University, is a gubernatorial appointee representing advanced practice to the Louisiana State Board of Nursing. He is active locally and nationally and numerous professional organizations and nursing, and he speaks both locally and nationally on a wide array of nursing and health care topics. So let's begin our program here today on addressing the demand for equitable, patient centered health care. And this is our blueprints for success, part of our virtual training institute. So moving forward, what is never consider ourselves finished nurses. We must be learning all of our lives. And that's a quote by Florence Nightingale in this year, the World Health Organization, or who designated this as the International Year of the Nurse and the Midwife in honor off Florence Nightingale's birth in 2000 and 18. Weaken see that almost 60% of the world's health care force is nursing, and that nursing workforce is the world's largest single occupation in the health sector and is the foundation for inter professional health teams that deliver the promise of health care for all. We look at the U. S. Bureau of Labor Statistics. We can see that in the United States. We'll need more than one million additional nurses by 2026 which is equivalent to 200,000 new nurses every single year. And in 8 2000 and 18 we had 13% of our registered nurses and 11% of our nurse practitioners who identified as black or African American. So moving on, we can see in this vin diagram the health disparities at the convergence of three pandemics. The Cove in 19 Pandemic and its disproportionate impact on minority communities has revealed the longstanding impacts of systemic health and social inequality. Inequities on health outcomes among black and brown people in the United States. So you can see each of these circles on the Ben Diagram Co vid 19. We also have, you know, injustices, racial injustices and HIV that intersect together in the Center for Health inequalities. So going forward, you can see that in the United States, progress has been made to really reduce the new incidence of HIV diagnosis. But progress has not been shared across populations in geographic areas. We look at this between 2000 and 10 and 2000 and 16 Southern states accounted for an estimated of 51% of new HIV cases annually, even though just 38% of the US population lives in that region. In addition, the South has the highest proportion of new HIV diagnosis, suburban and rural compared with other US regions, posing unique prevention challenges. So now let's examine those rates of HIV infection. So this live represents the rates of diagnosis of HIV infection per 100,000 population in 2000 and 18 among adults and adolescents by race, ethnicity and region of residents. The highest number of diagnoses of HIV infection among this population was among those again who resided in the South. And when we look at that, you can see among blacks and African Americans, we have the highest rates, regardless of the region of residence. When you look at the rates 51 almost 52 were in the South, 43 in the West, 42 in the Northeast and almost 41 in the Midwest. The highest rate of diagnosis of HIV infection in Hispanic and Latinos was 27 was in the Northeast, so let's move on to what's next here. This slide shows the rates of adults and adolescents living with HIV infection, the year in 2000 and 16 in the U. S. And six dependent areas. When you look at the rate, it's over 600 367 per 100,000 individuals. And looking at the map on the left, you can see the darker, shaded areas really show the highest rates of diagnoses, and so you can see the Southeast has the highest. When you look at the table to the right, the geographic HIV rates and African Americans are astounding. Look at the District of Columbia, which is the highest of all. Moving forward. In the recent months, Cove in 19 has swept across the globe, bringing immense challenges, including for tens of millions of people living with or affected by HIV. Cove in 19 has been the most lethal pandemic since AIDS emerged nearly four decades ago. So when we look at Cove in 19 it's really shine the spotlight or put us under the microscope. Ah, longstanding issues that have been influencing exclusion from health services. For example, the overlap between coronavirus hotspots with areas of higher incidence and prevalence of HIV point to the role a variety of social determines of health, including access to care, education, employment, housing discrimination, cultural competency or humility and quality of care and many other things that historically have affected disadvantaged populations. So when we do a little background around here, Cove in 19 is really impacting HIV response in three key ways. First, there's that shift of health care Resource is to focus on cove in 19 and national lockdowns that have severely affected HIV treatment and prevention services, including interrupting care and increasing obstacles to accessing treatment and clinical services. Second, coded 19 has exacerbated in other challenges for people living with HIV and key populations who are experiencing renewed stigma with evidence of increasing vulnerability, especially in the LGBT Q Community and third Coated 19 Pandemic is really highlighting that existing systemic level weaknesses in health care and supply change that is adversely affecting people living with HIV. So moving on, we can see here. This slide shows the disparities and the impact of Covad 19 by race and ethnicity, with a focus on the impacts of co vid 19 among African Americans. As you can see here that African Americans account for 12.4% of the total population but 22.1% of deaths from Kobe, 19 For people living with or at risk for HIV, HIV status is just one element of a person's health. And when we look at comprehensive behavioral and biomedical risk reduction services for the prevention of HIV and treatment for those living with HIV require an engagement in care. The steps along the care continuum are very similar. Sustained engagement in care is important to achieve and maintain health and HIV negative individuals may not be accustomed to that importance of sustained engagement and care. However, stigma and social determinants can influence HIV care continuum before an HIV diagnosis is even made. With that being said, I would like to start with questions from our panel and from you the audience. So I would like to start with Dr Rashida Chandler Rashida. Black people are so are disproportionately affected by those three daunting challenges. The Sendem IQ I mentioned earlier co vid 19 systemic racism and HIV. How do we as nurses respond to these crises? Rasheeda. I appreciate the question that Shiva and 1st may I request a moment of silence for those men and women who have been killed or who have died as a result of these sendem ICS. Now I would like to say her name, Miss Briana Taylor. In that vein, I want my responses throughout this discussion to be solution based and speak from a resilience perspective, even when reflecting on the challenges mentioned covert 19 systemic racism and HIV, and that these challenges disproportionately have a negative impact on communities of color. As nurses, we persevere in providing exceptional care, and we prevail as the most trusted profession in the eyes of our patients. Some other things we can consider our one nurses are experiencing these endemic in much the same way as others. Occasionally we take out by superhero capes, and we realize our humanity. As a black nurse, we have the additional intersection of race to contend with. I say to us that we need to institute self care measures. Personal time, journaling away, to debrief relative to stressful events. Yoga crashing, we say. Do you? However, you define maintaining your calm, your piece, your mental stability. We are caregivers for everyone else, but we have to be healthy mentally and physically to be best equipped to help others employers and other agencies who value who we are as a profession can provide free resource is for mental health, renewal and support and demonstrated in the keynote address, which was absolutely excellent last night. Resiliency and traumatic stress training, wellness initiatives, respite, morning rooms, wellness rounds, art therapy, dance and movement therapy memorials that honor piers, employer, employers and agencies who care about health and welfare of nurses will ensure we are prepared to combat emerging diseases like covert 19 with training equipment and empathy for our families, friends and life, the issues that linger like health and equities and communities of color. We have united drawing from NBN NAS policy stance through initiatives like NBN a day on the capital. We have master individual patient care. We need to continue our efforts and being population and global influencers. And secondly, I would argue that we have been responding to these issues, those that are old and new. It is baked in that we advocate for our patients and that we provide them with resources that accommodate their personal in health care needs. We will continue doing that. We are activists for our patients. We will continue doing that ways for us to stretch one. Create a movement starting nationally and disseminating to local chapters. Black nurses matter. We matter in being leaders and nurses, schools of nurses, nursing excuse me or even being promoted in these settings the institutions that dictate what the future nursing workforce will look like if it will reflect the changing demographics we matter and being in principle investigators on research conducted in our communities. We matter and being leaders in health care, setting we matter and being elected into county, state and federal offices to impact the systemic racism and the sub op, the more impact it opposes to communities of color, we must speak with our collective voices and relentlessly demand change. Wow, Dr. Chandler, you started us off with an explosion. I want to thank you for giving us out of silence. And one of the big things that you mentioned was self care for our black nurses and all nurses right now in this time, because without us being, ah, 100% we cannot help anyone else and then moving on to policy and advocacy at and it's just so important. So thank you for that. I'm gonna move on now to Dr Tavel Kindle, and I'm gonna ask you to Bell, at a time when black people are under extreme stress from multiple problems, what can we dio as nurses to keep our patients needs front and center? Yeah, so that's an excellent question as well and apologize for a muted. But certainly I think the most important thing for nurses toe understand is that you know, as healthcare professionals, we exist in a system that was not really set up for black people to be successful to navigate. In the first place we were, the system was not designed for us to benefit at all. And so once we come from a come from a position of there and help to kind of understand that, then we're able to then be able to understand what's what's causing stress. And it's likely that you will realize that the stress is being caused by the barriers that exist in the system that they're trying to navigate. So that's the very first thing that we need to do is make sure we understand what those barriers are, and once you understand what those barriers are, then it's important for you to be able to as the professional nurse to identify the re sources that are available. The resource is that are in the community and then you've also got to take that next step because again, as educated professionals, we often take a lot of things for granted that people understand how to navigate different things and do things for themselves. So take that extra step and and be that advocate for them and make sure that not only do you refer them to the resources that are available to them to reduce stress and help them to be successful, but you also help them to be ableto gain access to and be successful in getting what it is that they need. The other thing that we need to do is we really need to be informed advocates, uh, informed in such a way where we understand again that the system that we are operating in a such a time is this. You know, it's a wonder why we have the health outcomes and the issues and different things that we have is because we have all of these issues that are compounding in our communities and hindering black people from being healthy and and receiving equitable resource is to maintain optimal health. Um, and then another thing that nurses can do It's so important that we foster affirming relationships that also helps to reduce stress. It's so very important for you to make that connection with patients and help them to understand that, you know, you could very well be that, you know, you could very well, uh, you could. Very well, uh, have ah thought process in your mind in such a way that you don't really understand how black people are operating in a system that, you know, they're encountering people who really don't care about them at all. And so for you as a professional nerves to be there with them and help to foster those relationship with them to develop that trust and whatever is necessary for them so that they can be successful in reducing their stress and and being more healthy at a time like this. Thank you. Wow. That was a lot to unpack right there. But I think something very profile that you mentioned is that the system was not designed for black people. The health system was not designed for black people and we are stressed from trying to navigate something that was not designed for us. And the importance of the role of nursing in relieving some of that stress by the resource is is powerful. Doctor is very powerful. So thank you for that. I'm gonna ask the both of you and I'll ask Rashida to go first. What are the biggest barriers that stand in the way of Mawr? Equitable health, Health care outcomes. And that's aside from the system not being designed for us. How can nurses help to overcome them? Well, I have touched on this Ah, little bit in my previous statement, but of course I have more, right. Eso the barriers as I see them are our communities are talked to rather than cooperated with. It does not take a PhD for the community to know what issues need to be addressed in their respective communities. We are guided by patient report when we take a history and use that information to determine patient care needs, right? So why don't we do that when we award people millions of dollars to implement an intervention that in the ivory tower is the best idea since the voters right rights at We need to engage communities through the health care and research process, toe identify and prioritize outcomes that matter to them. Um, I want to give a personal story. My grandmother had 1/6 grade education, raised 17 Children and to me was one of the wisest women I knew. If a respect for citizenry at every level of education, socio economic status, etcetera is acknowledged, we can work together to overcome the barriers. Some of the women I work with appreciate being listened to, and I know many of you can attest to that. So in conclusion, many of the barriers should be expired by now. But I am preaching to the choir when I talk about this at M b N A. Because we live it every day, whether it is a personal encounter or the encounter of our brother, sister, cousin, uncle. We live it every day, and it is exhausting. We need our other colleagues and allies thio here us with us, and let's strive for equality together. Okay, we have did a lot in this first session, and unfortunately we have a time constraint. So the next round we will do a little more with that, But I'm going to move on now to disruptive innovations, and then we'll pick up the discussion after that. Thank you so much. So disruptive innovations and treatment and telehealth moving forward When the HIV epidemic began, a positive diagnosis was really considered a death sentence. But today, if someone's diagnosed with HIV and treated before the disease as far advanced, they can live nearly as long as someone who does not have HIV. And for black people, that is just really, really probably the same length of time, because our life expectancy is lower than a lot of others. Ah, look at history of HIV reveals a story of innovation and scientific advances that have resulted in significant progress against the HIV epidemic, although we're not there yet. After the HIV entered the public domain in 1981 early advances including basic scientific research into AIDS and the virus that was causing it, as well as the first test to screen for the virus and the first approved treatment, as you know, came early on in the eighties and in the second decade of HIV and AIDS, we had progress included studies on mother to child transmission with a Z T being the first drug to really stem that tide of infections in our newborns. We also had the first HIV test and the emergence of highly active antiretroviral therapy regimens that were able to suppress viral replication and slow the progress of HIV disease, which I remember after prescribing into many patients in the mid nineties. In the last two decades, advances have included improvements and regiment formulations and a better understanding of the benefits of HIV treatment and prevention options. Slowing the spread of HIV. Going forward, we can see that there are similar innovations in HIV treatment and prevention that have evolved across the HIV care continuum. The U. S Preventive Preventive Services Task Force recommends that clinicians offer pre exposure prophylaxis or prep medicines with effective a R T or antiretroviral therapy to persons who are at high risk for HIV acquisition. The Department of Health and Human Services say start our T immediately after being diagnosis diagnosed with HIV regardless of their tea seller 34 account to increase the uptake of a R T and linkage to care to decrease the time of viral suppression and improve the rate of suppression. The primary goal as of Air T, is to prevent HIV mortality and morbidity, as well as to reduce the risk of transmission to sexual partners and toe infants. Very important. So when art is used to prevent HIV transmission, this strategy is called treatment. As prevention or task, it is also commonly known as undetectable equals un transmissible or U equals you. In case you've seen that campaign, it really underscores that the fact that people living with HIV that take their medicines and achieve an undetectable viral load after about six months really have effectively no risk of transmitting HIV through sex moving on. We can see that highly active regiments have been available for people living with HIV for over two decades, and I've been there for all of them. But the characteristics of these regiments have changed dramatically over times. The old regiments that I used to prescribe or characterized by multiple pills, taken 34 times a day with drug drug interactions, food and water requirements, and required significant patient education and monitoring. These regiments also had moderate viral suppression and the potential for resistance really necessitating more frequent monitoring of patients they were living in the office. Current regiments now have a rapid viral load suppression, which is excellent as well as being very well tolerated. That means less side effects have a low potential for resistance and our parade dominantly single tablet regiments. So as we look ahead, though, despite advances in HIV, there are gaps in treatment and prevention that still remain. And these include sub optimal levels of people in care and people who could benefit being on HRT or prevention options that are not. And ultimately, these opportunities still exist where more people living with HIV can be virally suppressed and where HIV transmission could be prevented and those at risk for the virus. And this is that nice depiction of the HIV care continuum, starting with screening, Screening all clients is important, starting at age 13 by the C. D. C. Recommendations going up to 64 which is not fair for certain age people like May and then you go into one side of the other treatment or prevention, and you stay engaged within whichever side you're on. So moving to telehealth now can telehealth really be the next disruptive innovation in HIV prevention and treatment. Disruptive innovation for people that don't know this term is in term to suggest how to mend problems in the world and in illustrate how new technology can change an industry to make our lives better. Think about Fitbits and monitoring your heart rate, those air things that air disruptive innovations. But telehealth is 12 and we found that disruptions in healthcare occur around diseases for which an effective treatment exists. But the delivery model for those treatments continues to have gaps and care. So telehealth has been shown to really increase utilization, and we're currently experiencing a surge in telehealth because of Cove in 19. There are questions that still remain about telehealth in the long term, but hopefully we'll get to those and I'll give you an example of one of the questions providers air drawn to HIV, primary care for long term relationships and patient provider aspects of medicine. But during Cove in 19 Pandemic, many providers embraced telehealth. But what's gonna happen once the cove in 19 pandemic subsides? How will telehealth be utilized after it? So now let's take a look at the pandemic that has forced primary care, especially health care providers to adopt virtual care and telehealth so patients can still receive care while social distancing and medical resource is can be re allocated to the front lines of treating Cove in 19 patients. This lied is really impressive because it shows Kaiser Permanent, one of the largest health care providers in the United States, is now reporting an average of 65,000 telehealth encounters a day. Their video visits across the country grew from 8500 to 45,000 day by June of this year and their eggs. Other examples that are on here that I'm not gonna go into. I just wanted to highlight how it's increased. Civilization has occurred, so moving forward telehealth may serve as a disruptive innovation in HIV healthcare. However, there's still some questions on how best to use this telehealth to expand access to health thio HIV care. There's some potential benefits here. Decreased waiting times. Nothing like that. Expanded or more frequent clinic hours. Stigma reduction, reduced unintended disclosure when you run into someone in the office that you know increased access to health care providers, opportunities for health, HIV health education and increased patient support but we do have some potential challenges here. We still have reimbursement policies that we have to actually think about that we didn't have before. Access to video equipment to do telehealth privacy concerns You know, people hack into our EMR system's. We also have regulations and policies in place that limit prescribing and patient and provider uptake. So as we look ahead telehealth, maybe an effective way to expand HIV care, particularly in rural I'm in Texas, rural or remote settings hard to reach populations such as those people who are incarcerated. Younger people without core morbidity, ease and telehealth may be used to reduce transportation barriers. People can't get in. They're out of a job during Cove in 19 and can't drive and improve engagement in care and medication adherence, reducing and resulting into an HIV viral load. So going to our next line, you can see innovations will continue to shape the HIV epidemic, while today someone diagnosed with HIV and treated again before its advanced as someone who does not have it can really live a long time and HIV is prime for the next disruptive innovation to really help address gaps along the continuum, so think about it. Can telehealth be the next disruption? So let's go back to our panel and ask them a few questions. And now joining us with Rashida and travel will be Deb. Okay. Hello, Chris. Hello, Deb. I'm so glad you could join us. I'm glad to be here with the evolution of HIV treatment in terms of viral suppression, tolerable ity and dozing. I'm sorry. With dozing and with innovations in HIV prevention, how can we ensure that black people who are disproportionately affected by HIV gain better access to care? And I'm gonna turf this to, uh to Bell, since we didn't hear him on the last question so developed, What is your viewpoint on this eso? So that's a really good question. I consider the privilege to provide care for people living with HIV, and I do believe that one of the things that we can really do to help toe gain access is to educate people on what's available. I do find that there's still a lot off lack of education with regard to the advances and in HIV treatment. Uh, one of the things that really helps, uh, kind of inspired me is when I get someone who returns to care. And we placed him on the newer medications and they're like, Oh, my God. You know, if I would have had this, you know, 10 years ago, you know, I wouldn't just wouldn't even be an issue. And so I am able to appreciate where we've come with regard to our evolution, you know, through the lenses of, you know, people who have been living with HIV for some time and have had to, you know, kind of deal with a lot of the side effects and the issues and the challenges as it relates to big Festival on very complicated. And Richard about therapy, you know, historically, but ah, lot of people are unaware of treatment effectiveness there, unaware that there are single tablet regimens. You know, you're just taking one pill once a day now. And, you know, I think when we get to that point, where were ableto get more education, Uh, you know, out of people that they will be aware. And there there'll be more absolute, you know, to come in and thio to receive here. I think another important point to is that we need more HIV treaters. And certainly there's gonna always be a need for Specialist. I think that sometimes people who are specialists believe that, Oh, you know HIV needs to remain as a specialty off to yourself, and it should not be done in primary care. But let's face it is not enough of us. There's not enough of probably your care. And so we all really need to be, you know, working together to try to help Thio increase access. So that's going to require training that's going to require mentor ship. That's going to require a lot of different, uh, components in terms off, making sure that that there's someone available, you know, you may not. You may be in a rural area you may not be able to immediately refer. So what does that mean? We know that the science tells us that, you know, the sooner we could get someone or in a richer by therapy, you know, the the sooner they become suppressed and that that would mitigate any, uh, you know, advanced healthcare outcomes that may result in them being not treated. So we want to get them started as quickly as possible. Why should you have to wait for them to go to a specialist when you can start that right there in primary care and get them moving in the right direction. Um, s O my research interests really did uncover in my PhD program, you know, a lacking knowledge and certainly, uh, stigmatizing attitudes of different things among nurse practitioner providers with regard to HIV prevention and treatment. So I as my as my educators Listen, I I really hope that you kind of take a look at what you're doing in your primary care programs with regard to HIV prevention and treatment competences and make it such that when your nurse practitioner graduates come out, you're not preparing them to be specialist. You're preparing them to be, you know, to provide good primary care. But let's face it, we know that our primary care providers are taking on war advanced patients, and so where they need to be prepared for that. So those are the things that I think that we can dio gain more access or increase access to people living with HIV. Thank you. Travel. That was a lot. And that was a call to action to the black nurses, right there Education, advocacy, awareness, less stigma, education. We need more health care providers, especially in primary care. This isn't for necessarily and HIV or infectious disease specialist. This is for everybody, because this is our community. So thank you for that. So I mean, you know what? Can I just add something to that step, brah? E think I think that travel made a very important point. And as we as educators and as black nurses in our community, one of the things that we have to think about is, you know, we're seeing people who may be at risk for HIV or who are coming in in primary care. Ah, lot of them. You know, we have lots of data that shows what travel talked about, which is, You know, people come in for primary care visits and their HIV is missed, or the opportunity to talk to them about prevention is missed. And so, as health care providers and as reliable sources in our community, it's important that we, you know, educate ourselves. But we also educate our family members and other nurses so that we don't miss those opportunities to educate people and to get them in care a soon as possible. Thank you for adding that dub. It's It's really very important again. To highlight primary care is where it's at and ends by not missing opportunities. I've heard stories of many people going to primary care that have missed opportunities for a diagnosis. And they went on toe having an AIDS diagnosis because it wasn't recognized that they were at risk. So thank you for that. I mean, I'll go thio Dr. Chandler to Rashida. What role can nurses play to increase the awareness in the black community in the community table? Got the nursing programs together UN effective prevention, testing and treatment options. Well, I appreciate all the comments that have been made, and I think we're on the right track. Thio getting ourselves prepared so I'll try toe touch on the community. And, um, I could give some examples of what my agency does, and we are very fortunate to have toe work with family support specialists because as we uh, no, that this is a team effort. We're all in this together and in our in your particular office. These team members maybe identify as, like, outreach workers or patient navigators. Um we have community events like health fairs that enrich the community, Um, in in the time of covert 19 and even before I have been interested, uh, expressed in my bio and technology and how it can supplement health care services. And I recently did some interviews with black women and inquired about what technology innovations would be useful for them pertaining to sexual and reproductive health. Um, they expressed a need form or culturally and contextually interactive technology tools like mobile ABS and interactive gaming. They also indicated that social media would be a valuable tool to convey information about resource Is, um we instituted a telehealth program and we are currently working on some of the other technology tools that were expressed, and we have created created alternatives like getting testing, prevention, options and treatment at home. Um, some approaches can be online Onley hybrid. Um, some patients will want to continue with the traditional face to face medical model, and I do believe telehealth will remain a very formidable service in the healthcare sector, and other technology innovations like virtual reality will become more prominent in the healthcare sector. So those are some of the things that I think of when I think of enriching, enriching the community or reaching out to the community that we can utilize. Thank you for that. These are exciting times. So now and especially for you, Queen Bey, you with your talking all this. It's so wonderful. So we're going to take what we've talked about and put it into a case study. So we're going to move on to a case study for you to participate in. So it's putting it into practice, and I am going to give you the skinny here on this person. This is a 24 year old gay man, and he lives in southern Georgia. He lost his job due to Cove in 19 Impact and now has limited transportation. He's in a relationship, expresses medical mistrust. No surprise there no local representation among physicians regarding race or sexuality. He was diagnosed with rectal gonorrhea one week ago and admits to possible exposure to someone living with HIV. Last night is worried about getting HIV due to co vid 19 pandemic and wants to know how he can prevent it. So going forward, let's turn our attention to our Panelists for a Q and A So I'm gonna ask. I'm gonna start with Deb first. Want to hear your voice? A little more. All so deaf. What else would you like to know about the patient's medical history and sexual history? Well, I like, um, so he's 24 years old, so he's young and he's living in Southern Georgia. They probably don't have expanded Medicaid there on DSO. I mean, I think things to find out is what is his family situation? What is his support system? Who does he live with? Onda, Who are some of the people that he trust to get information from? Hey, doesn't trust it, doesn't trust the medical system or he has some issues with that. I think the biggest thing is, where does he live? Who does he live with? Um, has he had ah, primary care physician before? You know how maney STDs has he had before? Um, and then what does he know about prep? And if he would be interested in learning something about prep And then I think the other thing is Thio, try toe talk to him about what his medical mistrust is about. You know what? If things have happened to make him feel that way and see if those are some things that I could address to instill some kind of trust in this relationship because it's hard toe. It's hard for people to talk about their sexual life for their sexual history if they're not comfortable with the person that they're saying so those were just some of the basic things that I think I would try to understand. And if he does not have, if he's lost his job, I think understanding how he's gonna access medical care is gonna be really important to. So those are very valid. Very all of those air, very important. And a lot of people push back because we say, Oh, we don't have enough time for that But this is how we help people. We have rich narratives, so thank you for that. So Rashida, you look like you want to jump in bad. So I want to just add on a little bit, you know, Deb got to cover. I just had a few little little things that that I would ask him, too, because he says he's in a relationship so and now he's worried about HIV, so I wanted to know if that relationship with discordant or if he had, um, outside partner where he suspected he might be, um, exposed to HIV. I also wanted to get a little bit of information, maybe because they have already addressed his medical mistrust. So we have that report now, and we can talk a little bit about his sexual partners history. Um, is he using condoms when he does have sexual in counters? Also, want to know a little bit about if he exchanging sex for money or resource is because he did. Did you lose his job? And so, uh, those would be some things I would ask for. It also had he been treated for Director GC because I know, he said, I think he had been diagnosed, but I wasn't sure if he had been treated for that. And then also, when his last HIV test was, um but definitely picked up on most every other thing, I would would would ask some. Those are excellent points. You mentioned a term that the audience may not know this. Could you briefly give a definition of that? Yeah. So? Well, where one partner is, uh, HIV positive and the other is, is not HIV negative. Thank you so much. Also mentioned, Having resource is or exchanging sex for resource is, and I just wanted to tell the audience here, this could be Louie Baton shoes. This could be an iPhone. It doesn't have drugs or shelter or much whatever it could be. Whatever you don't have and you want it could get to get your car. No page. All right, so Tavel, let's let's go to you Anything you want to add that the other two Panelists have not mentioned that you think is relevant? No, honestly, I don't I don't think there's anything else I wanna add. I think they did a really good job of covering the five p s. When you think about taking a sexual health history and wanting to know a little bit about, you know, kind of where this person is. I because it's we know that he's just looks like may have had a recent history. I would really be wanting to kind of move him forward towards being on post exposure prophylaxis and kind of get helping him toe understand a little bit about what You know what that it requires for him and and the importance of that and also his understanding of that and also just his general understanding of what HIV is. I mean, he's 24 he's living in America in 2020. Let us not take for granted that he is fully aware of what HIV is and how you can get it. Brian. So let's step back for the people that don't know what pep is. We don't need to talk about brand names, but just explain what the process is on pep TiVo. So, uh, Pam, for post exposure prophylaxis is Anna Richard Brown medication that a person who had an HIV exposure regardless of the mode of transmission, be the needle stick or sexual exposure, whatever they take this medication for 28 days and and we have evidence to support that when we do that with regard to guidelines, one of that, it reduces their risk for acquiring HIV next. Excellent. Thank you so much for educating our audience that might not be aware. We dio Let's see the next question I would like Thio give Thio Deb in this climate of Kogan, 19 how would you go about assuring the patient about the safety of visiting a lab before initiating HIV prevention Pharma logic intervention so it could begin as soon as possible. Well, I think, um, you know, some more history needs to be involved here, right? Like, who does he live with again and any possible exposure to cove it And, you know, making sure that he understands that being 6 ft apart from people wearing a mask, washing his hands and taking care of his personal health, I think those air still the most important things that he would need to do before he goes, um, into a laboratory, Um, and before in HIV prevention interventions e mean, I think that's a lot of education, needs to go into that. Still to educate him about what prep is and what prep is not. But the most important thing is that if he's going to go to a lab to get tested, that he, you know, make sure that he's wearing a mask. He doesn't have a fever. He washes his hands, stay 6 ft away, understanding how he's going to get there. If somebody's gonna take him, are they gonna have on make sure they have on a mask if he's gonna be in public transportation that they have on a mask. I mean, I think some of those basic kinds of things that we're all living in today's world is what he would have to be doing. That's a great start. And I would add to it really educating our patients that the labs have to follow CDC guidelines on cleaning and masking and washing their hands, too. So way. No, don't want to go to hospitals and labs because they're afraid they're going to contract Cove in, so they have to follow some guidelines to. So that's great. Thank you so much. We do have some more questions for you, but I want to take one from the audience really quickly. Here it is. What is one of one thing that you think and this is to the Panelists? Should be we should be doing is black nurses to combat the issues of structural racism in health care. Wow, So that z a presser? Pretty deep question again. I think it really goes back to fundamentally. Do we, as nurses fully understand just how deeply rooted racism is? Do we understand how deeply rooted things. You know, things are in terms of the inequities and how are how are society is and how it how it's been, you know, over time how we've had to kind of content with all of this. You know, I was in the training not long ago, and they were talking about how do you define racism and that, you know, you have to realize that it's prejudice plus power. And so we as black individuals, oftentimes we don't have the power. You know, we way exist because we are allowed to exist in certain spaces and that, you know, the education that we receive and all the decisions and the policies and everything that's been made in this society has been developed by white people and have and we allow, you know, we are allowed to kind of, um, you know, exists in his face. So you've got to start their, you know, making sure that as nurses that we understand that. And then we arm ourselves and have ourselves, uh, at in places and in spaces and have seats at the table so that we can, you know, inform our like white allies and help them to kind of understand what it is that, um, you know, that needs to occur and help to influence them. Because while we may not always have the power, maybe influence them in such a way where we can get where we need to get to in terms of improvements that are net that are desperately needed right now what I'm hearing you say there's a lot of work left to be done, E I think What other things, too, though, is as as, uh, black people taking care of black people is really, um, comes from the workshop we did yesterday on cultural humility and stigma that so many times black people get pathologize about who we are. You know, black single mother like that's some bad thing, you know, or you know where you live, your ZIP code. Something is wrong with that. And I think we have to doom or to educate our patients about kind of self determination and and instill some pride in who they are and not have them succumb to the labels that are put up on them by people. I mean, like most people, if you ask them where they live, they don't say I live in a disenfranchised neighborhood, you know, they'll tell you where they live. They don't say I'm a marginalized person. And I think that that's that. All of those terms are what perpetuate the structural racism. And I think we as black people and as black people who are trusted as health care providers in our community can help educate our patients about those kinds of things that are placed upon us. And we don't have to accept those terms. So no, I'm no just really quickly. Everyone, um, provided such great feedback to that. I only have, You know, I just would go, um, and agree with things that have been said, especially in the key note by Dr Dawson. Um, with policy um, inequities. Um that's where it starts. You know, we're land, you know, Hopefully we will remain a land of, uh, that we have to abide by laws on DSO. You have to be in that system where you are influencing those laws and being able thio so that you know, then we can impact our community at a community level. But it does start with us being activists in those spaces s so that we can lead the charge on some of the initiatives that would help to improve our community. So that's what I say. Let's start a movement and let's, like, get on this policy train here. I love it, and this has been such a robust discussion. We have another question from the audience, and then we're gonna have to wrap it up. Unfortunately, even though the stimulating and it just got really good, we're gonna have to go through this last question. This is how can we reach black women and the people they care for with the information they need to understand their HIV risk and access appropriate HIV treatment and prevention options? I guess that's like, I ain't directly at me, um eso you know, I'm working on that, but I want to say, first and foremost, I'm working with my other black women in the community that I am, um, a part of. We are working together. Everything that I do is community based participatory research. So I'm literally in the community with them, asking their opinions, getting their feedback so that we're creating something that could be sustainable and hopefully be more generalized. Herbal So, um, with that said, there are a number of things that let women have expressed to me. That would be useful. Um, again, Uh, something that could be used that is not just kind of regional or in one setting would certainly be facilitated by technology. Which is why I put a huge emphasis on it. Um, And so, uh, you know, kind of f y. We are working on some technology tools to be able to reach black women and making it culturally relevant. We have done some prototypes, gotten feedback from them, and they have indicated what needs to be changed. But really, um, the black women have told me that they want to see people who look like them giving them their information. Eh? So we need to produce mawr healthcare providers who, um, do look like these women and who they trust, um, and can provide, uh, the information with and I'm having to wrap up. But just know that I think we are on the path Thio addressing the issues that black women are wanting. And we're trying to get those tools that they're saying they need out to them. Excellent. Thank you. So much. So in wrapping this today, we really had an open and robust discourse that covered three importance of incorporating holistic HIV prevention into conversations about sexual health, innocent Dimmick of co vid 19 HIV and racial injustice. Unfortunately, as you know, this wasn't long enough to provide solutions to all the ills black people face. But it was a great start, and nurses can support this continue and will support this with their patients and this radical time more than ever. So I want to thank our dynamic panel for their contributions to the NBN a and their communities in which they serve and know that you are value. And I would also like to give a shout out to Chauncey Watson, soon to be PhD who put this together and the crew from clinical minds for your support. Thank you so much for joining us today and have a blessed conference. Thank you
