Chapters Transcript Video Blueprints for Success: Understanding and Addressing HIV Risk in Black Communities Blueprints for Success: Understanding and Addressing HIV Risk in Black CommunitiesOriginally Broadcast: February 9, 2021 7:00 PM - 8:00 PM EST Hi, I am Chauncey Watson, associate director for HIV marketing at Gilead Sciences. And on behalf of our employees worldwide, we would like to welcome you to understanding and addressing HIV Risk in Black Communities, a joint program hosted by the National Black Nurses Association and Gilead Sciences. I want to begin by thanking all of you all for the work that you're doing to support communities impacted by both HIV and cove. It, your workers leaders on the front lines is critical to the goal we all share. And that is seeing the end of an HIV epidemic led by dedicated an auspicious panel. We hope you find this panel and program informative and inspiring at the important intersection of Black History Month and the National Black HIV and AIDS Awareness Day, which occurred just two days ago. Thank you for coming. And thank you for your consistent dedication and commitment to your profession, your patients as well as your communities. Without further ado, I have the pleasure of welcoming to the stage virtually Dr Sheldon Fields who were service. I moderated for today's panel. Dr. Fields. Yes. Good evening. And thank you, Mr Watson. I am truly happy to be here this evening, and I want to add my welcome to our program this evening. Understanding and addressing HIV Risk in Black communities Ah panel discussion in conjunction with the National Black Nurses Association, made possible by Gilead Sciences, as Mr Watson shared, I am Dr Sheldon Fields, the associate dean for equity inclusion in a college of nursing at Penn State University and the first vice president of the National Black Nurses Association. I will be joined this evening by three esteemed colleagues. Dorcas Baker, the regional coordinator off the Mid Atlantic AIDS Education and Training Center at John Hopkins University School of Nursing. Dr Chrystal Chapman Lambert, associate professor at the University of Alabama at Birmingham School of Nursing, and Dr A. Shockey Phillips, family nurse practitioner in HIV prevention coordinator at Well Spaced Health. And we'll get to that conversation after some introductory remarks. So as we continue with the present patient, we're coming together this evening during Black History Month in having jazz marked the national Black HIV AIDS Awareness Day on the seventh, sometimes also referred to as national black HIV AIDS Testing Day. The intersection of these two significant events comes at a time of great progress, yet enormous challenges. Brigadier General Hazel W. Johnson Brown, the first black woman general in the military and the chief of the Army nurse course, has stated positive progress towards excellence. That's what we want. If you stand still and settle for the status quo, that's exactly what you will have. We're nursing, are not satisfied with the status quo, and we never have been. Despite efforts to advocate for our patients and members of the black community, many obstacles remain in the way of progress for our patients and gaining access to HIV testing what, as we move on, not the least of which are the social determinants of health, the social determinants of health for those conditions in the environment in which people are born live, learn, work, play, worship, age, I often at die that affect a wide range of health, functioning and quality of life, outcomes and risk for blacks in the United States. It is the social determinants of health that are so closely linked to health and equities that includes racism, poverty, lack of access, the healthy foods environment to exposure and look no further than the case with Flint, Michigan, in the lead in the water and criminal justice or rightly so, criminal injustice as social determines of health have shown US medical care in nursing will not solve a lot of the problems and interactions with patients. Nurses, however, are uniquely qualified to assess the presence or absence of associative determines of health and helped link patients to appropriate resource is as needed now. While Kobe, 19, did not create the disparities in health care that we've seen, it did most certainly show the depth and breath of what was already there into further enunciate these points of 677 disproportionately black counties. In other words, we're talking about counties in which the population is composed of at least 13% black Americans. 91% are concentrated in the southern United States, not on Lee. Our rates of unemployment, lack of insurance high in these 677 counties, but so were things such as diabetes, heart disease in HIV as well. Now, according to the Kaiser Family Foundation, the South has relatively higher numbers of poor, uninsured adults than any other region. It has higher uninsured rates. Mawr Limited, Medicaid eligibility than other regions and accounts for the vast majority nine out of 14 of the states that opted not to expand Medicaid. As a result, more than nine and 10 people in the coverage gap reside in the South. Things such as transportation, social health services are vastly inadequate. In a lot of these more rural areas, there is such as there is slow adaptation of the latest HIV testing, treatment and prevention to services Now, as we continue to look further despite major advances in HIV treatment prevention, ethnic, racial and sexual minorities, however, continue to face higher rates of infection than the general population. In 2000 and 17 of new infections reported among men in the United States, 56% were among black in Latin X men who have sex with men or M S M, which is a group that makes up less than 1% of the entire population of the United States. If trends of HIV infection from 2014 to 2015, however continue, approximately 41% of black M s M in approximately 22% of Hispanic M S M in the United States will be diagnosed with HIV during their lifetime. Based on data from 2000 and nine through 2000 and 13, the lifetime risk of HIV diagnosis is approximately 17 times higher and black women and more than three times higher in Latin X women than white women. So, based on data from 2006 to 2000 and 17, the HIV prevalence also in transgender women is 14% compared with less than a 0.5% among US adults. Overall, we know that the disparities are there and we know that they do continue so as we even look further. Based on a meta analysis of studies from several countries, black M S M, however, engaged in fewer not MAWR, fewer HIV risk behaviors than did other MSF. They had less unprotected anal intercourse with a main male partner. Fewer male sex partners used MAWR condoms during anal sex and were less likely to engage in any type of substance use. Despite reporting mawr preventive behaviors, black and SM had a threefold greater odds of testing HIV positive and a six fold greater odds off having undiagnosed HIV infection due to the intersection of things such as discrimination, stigma, poverty and other socio political disadvantages. Now diagnoses of some sexually transmitted infections were greater in black and SM than in other black and SM. However, the results of a progressive observation all study in 803 black and white m S M in the city of Atlanta found a significantly higher rate of HIV diagnosis among black and SM when compared with white m S m, which was not attributable to individual risk behaviors. The research has shown us that many HIV related disparities for black M S M with those related to HIV, clinical care, access and use, and structural issues again, such as low income unemployment, lower education, incarceration as well as sex partner characteristics rather than disparities in sexual and substance use risk behaviors. Again, elimination of these disparities in HIV infection and black M S M cannot be accomplished without addressing the structural barriers are the differences in HIV, clinical care access and outcomes. So as we look at in moving on in terms of the gay bisexual in other M S M, that accounted for 70% off infections and diagnoses in the United States in 2016, despite representing a mere 2% off the population. But yet when you look at among the almost 375,000 CDC funded HIV test provided and non health care facilities in 20 southern jurisdictions in 2016 Onley, 6% were provided to black M s sound, who accounted for a staggering 36% of new HIV diagnoses among all persons tested and non health care facilities in these jurisdictions. So how, then, as we look further, how is it possible in the 21st century for this type of disparity? Toe happen? Based on a 2012 2012 survey of 544 black M s, um, 29% of participants reported experience in racial and sexual orientation stigma from health care providers, and another 48% reported having a mistrust of medical institutions. You know, the racial and ethnic disparities and health related outcomes among people living with HIV are very well documents compared to other racial ethnic groups, blacks with HIV or less likely to be engaged in care to receive antiretroviral therapy or art, and to adhere toe art, all of which may contribute to their lower survival rates. Latin nets with HIV are more likely to be diagnosed later in the disease continuum e with AIDS concurrently, resulting in greater delays and care entry as well as our use black and sm living with experienced stigma from health care providers, which was associated with longer gaps in time Since last HIV care appointment, black M S M living with HIV often reported greater levels of medical mistrust and stigma also were less likely. Toe have a high CD, four count higher viral loads, and we're more likely to have visited the emergency department in the last six months. Compared with Latin X, M S M LGBTI Q Plus people and people of color living with HIV for at least two times is likely to experience physically rough or abusive treatment by medical professionals when compared to their white counterparts. And less than half of all that next M S M living with HIV are receiving medicine to treat their infection. Initiation of HIV prevention services is much lower among black men, Latin X men and women when compared to white men. Approximately three quarters of men who have a script for pre exposure prophylaxis of Brent medications are white and on Lee, 9% are black, and still these types off disparities continue now, as we think about how did we get here? Let's think about that question. One reason is the legalized normalization of oppression. As we move on as seen from 16 19 to the president, you know, laws were passed in and around 1954 that outlaws things like segregation. Yet the long struggle to disentangle systemic and equity has continued. These micro level events impact black engagement with our health care system is subsequently the ending of the HIV epidemic in black communities. We did not just get here in this time line represents, ah, lot of things and the hallmark 16 19 when the first slaves were brought here. Till now, we really need to understand why things like the black lives matter movement came into fruition and how this directly impacts health care disparities. So as we move on and we now talk about nursing in particular, I've been a nurse for 30 years. I love my profession, and nursing is the largest health care profession in the United States, with some more than 3.8 million registered nurses nationwide. That's 2017 data. So we're getting pretty close to four million. Nurses comprise the largest component of the health care workforce and our primary providers of hospital patient care, and we deliver most of the nation's long term care. Aziz well, however, we do not have a nursing workforce that truly reflects our diverse society. As a 2017, the National Nursing Workforce Survey found that nursing remains upwards of 90% female and 80% white. Nursing programs should increase the diversity of their students so that patients conceive themselves reflected in their health care providers. This can help increase the likelihood that patients will get tested, receive HIV treatment and sustainable care again. Nursing is not a diverse profession because nursing really has not had not done the work it needs to do to move beyond this. Now, how does this then play into stigma in health care? Well, as we can see next, stigma in health care settings appears tohave a much greater impact on HIV related health, then does stigma experience in the community and can hinder one's progress throughout HIV care. Now you know, patients to experience stigma in health care settings have been shown to have non suppressed viral locals. These findings have implications for health care professionals, as respectful interactions with people living with HIV really are critical to one's health. Some steps that can be taken include making sure that forms that ask questions about identity have writing options so that people can write in their own gender their own race in their sexual orientation. You really need to let people self define who they are, ensuring that the space created is accessible and comfortable reflecting on how power structures or perpetrated through space design. Think about your clients providing sitting next to each other. No, rather than facing each other across the desk, you really need to think about training all your staff, including that support staff. Make sure that even the janitorial staff also know about the availability of things such as a drink, gender neutral bathroom as an example. And we need to work on cultivating and learning culture so that staff feel comfortable asking for training or information if they do not know how to meet a clients specific needs. So you know what the question then really comes down to As we look on, How do we become Mawr solution oriented directly addressing barriers to care is an important component of HIV programs. People living with HIV, I would like to say thriving with HIV stigma is a barrier that has been shown to have effective consequences, such as negative self image social consequences such as social isolation, healthcare consequences such as a decreased access to an engagement in care in behavioral consequences, including poor medication. Adherence. Several strategies can, however, be effective in addressing HIV related stigma, including engaging the community by doing some of the following. Help institutions to recognize stigma and bias. Expand our access in use. Addressing social stigma and the environment. Responding to the needs of stigmatized populations, using such things as the media. The show that AIDS has a human face. Initiating anti stigma campaigns involving people who are actually thriving with HIV in the actual service delivery of their own care. Now, until we have the uncomfortable conversations and become more solution oriented, these barriers in the biases will persist. Let's now ask our Panelists about ways to engage without black patients to increase prevention, testing and HIV treatment in a model that sustains not restraints or retains individuals in care so we're now going to turn toe a discussion with our three distinguished Panelists. Good evening. Good evening, everyone. Everybody looks so great again. You know, Miss Baker, I'm gonna come to you first this evening. What role can nurses play? An increasing awareness of effective prevention, testing and treatment options. Not on Lee in the black communities, but in those communities that are also aging. Because I know that's one of those areas you you have worked in for quite some time. Thank you, Dr Fields. First of all, if even having me to be, I'm honored to be a part of this panel with these distinguished Panelists. And I really appreciated that presentation because it just brought everything back to focus of what we're really dealing with and to answer the question because I want to stay focused. You know what nurses have always been? Leaders, teachers and advocates. I don't care what platform or what level you're working in or where your area of work. Maybe. But we have a sensitivity to see that when things are wrong. And that's something that we'll probably talk about. This we go recognizing, As you said, being solution oriented, we can play a huge role just by being a leader. That means we're the advocate. Nurses initiate things even in your own families. You initiate people come to you and your trusted. So we could do a lot by looking at the community that we are serving and seeing what role? As a leader, As a teacher, as an advocate, What can I do to make a difference even if it's starting with a small change? But people catch on to whatever you suggest if you go about it the right way. I believe we have a huge role to play, and I know we'll talk about it. Maurin our conversation so I'll just stop right there. Okay, Thank you for that. Um, Dr Phillips, you know, we know that black communities have been disproportionately impacted by the ongoing systemic racism and things like the covert 19 pandemic, and I'll continue HIV pandemic. What can nurses do, especially in the primary care setting to help improve the access to HIV prevention, testing and treatment amongst those black patients? I would like toa echo first by saying thank you, Dr Fields, and everybody for having me here today. This is a wonderful opportunity and to answer your question. So first we have to talk about how do we just provide that access to people in general? Because a lot of people are not getting access to HIV prevention, testing and treatment in primary care. So if we really want to cast that net and reach out, Thio are black population. We gotta make sure we have a wide enough net to start that casting in the first place. So first in primary care, we really need to start normalizing sexual health and HIV prevention and HIV treatment right? And we really start tohave interventions that were implementing where we make sure that we're capturing those things and providing access. So, for example, at our health center, we started an HIV risk screening tool. This screening tool has four questions. We use it kind of like the P H Q two and P H Q. Nine, where we ask people about their risk taking behavior in order to determine hey, should this person be talking with somebody about prep or even just to open the conversation in general about sexual health and HIV testing and treatment by casting that net where we're allowing people to just for everybody to talk about. Their HIV risk practices were definitely allowing the opportunity to provide more access to our black patients. Other things you could do to cast that wider net is making sure you have providers that are trained on HIV prevention and how to get clients into care if they do test positive making sure your provider, um, is listed as a prep app provider, making sure your prep app site putting your health center on the prep provider Locator thes. They're kind of like the bigger things we could do just to provide access in general. Now, of course, though, if you really want to make sure that you're reaching our black patients, you do have to do more so you can do other things. Like we did a text message campaign where we stratified a list of patients that, based off of their I C D 10 code, indicated that they may be at risk for HIV, or we should be talking to them about sexual health. So somebody who maybe was diagnosed with an S T. I in the last couple months, yeah, thousands of patients, then we stratified are list in order to put people of color first. And we send our text message campaign to our people of color first to make sure that we were actually implementing interventions to reach people of color and letting them know, Hey, we provide the services now on Lee. Did we do that? We actually made sure we hide text that said the fax. Hey, people of color are being hit harder by HIV. Let's talk about this. And if you want to talk about this, this is how you get in contact with us. So we made sure we were not only just casting that wide net to provide better access to everybody, but also reeling it on in and making sure that I brought population knows what's going on that services all nurse run. Mm. Well, actually oh, all of this was by a nurse and my team of often people here who helped. Absolutely. Absolutely. Now, you know what, Dr Lambert? I'm gonna turn to you, you know, let's think about what black nurses in those research settings conduce you. They're gonna increase the overall awareness of the disproportionate and negative impact that those social determinants of health are having on those individuals access to HIV prevention, testing and treatment. So, as a researcher, what do you think we need to be doing? Okay, um, again, like everyone else has said, I am honored to be here. Um, I feel like this is a loaded question. Right? Um, in order for black nurses to be change agents in the research setting, we have to be in the research setting again. Organizations must review their hiring policies and their practices to make sure that they're equitable. If we're not there, we can't do the work. Um, nurses, You know, once there they hair black nurses need access to resource is so in academia or in the research setting, we need funding. We need funding so that we can do the work that we're passionate about. Not just not just the work that we want to do to get to get research grants to get publications. So this is our community, and we're passionate about this work, so we need those. Resource is funding mentor ship sponsorship. We need those people who are sitting at the table who are going to advocate for us to be at the table so that we were able to share some of our strategies. Um, and we need correct career development opportunities to do the work. Um, you know, as we know, black nurses are in those settings and they are already doing ah lot of this work. So I think that black nurses need to continue thio advocate to educate their colleagues about the impact of social determinants of health. Because, honestly, not everybody knows about social determinants of health. They don't understand them. They don't understand how they impact health outcomes, um, and bringing awareness to inequities in in their in their setting and and how not only do the social terms of health impact health outcomes, but how they impact the research setting. I think it's important. Um, yeah, And I think, you know, black nurses can also reach back in and educate the next generation of nurses about how these social determinants of health impact health for our patients and also educate our patients because they may not understand. Yeah, yeah, it's truly you know, back to that statement that when it comes to that that research there really shouldn't be nothing for us or on us without us troops and We're just not the research technicians. We are the researchers. The P I. Yes, yes, absolutely. Thank you for that. You know, Miss Baker, you know, we often hear that whole moniker. We talked about it nursing the most trusted of our nurse of all professions that we talked about earlier. But talk to us a little bit, Mawr about what black nurses conduce do in those local communities that leverages the truss that that the community has in us that we can use to help increase that access to HIV prevention testing in treatment. When those social determinants of health oftentimes limiting or preventing that access. That's a great question. And listen, as I said before and as I've always felt, nurses are educators and advocates, you don't care if their social determinants of health there you have to know how to plow through. Regardless. When I started my nursing career, I was a research nurse, and that was, uh, 29 years ago, working as an HIV when I answered that ad to be a research nurse and I was determined because I saw that there was a lot of stigma which still is today. But there was something that was blocking me Being able to encourage our people to enroll in clinical trials, going back. You know, in 1992 with HIV clinical trials, that was very difficult. But I felt I wanted to plow through. There was barriers and all the way up until now, I am no longer researchers. But even now with this the stigma and discrimination there still things that we can do. We are trusted. Nurses are trusted more than anybody else. I don't care what your social workers nurses. We have such a strong, uh, trust level we should take ah, hold of that leverage that, like you said, in spite of, uh, not having to deal with leaving those social determinants of health care plow through if there's lack of nutrition in that community where people can eat you know, corner stores and the liquor stores plenty of those in our communities. But how do we deal with that issue? Even if we gotta advertise and then put up a flyer HIV, Israel, with our communities, gathering people, having that conversation, no matter what it is because where you live, that's health care. Transportation is health care. Uh, not having enough money affects health care. So it all is like almost one thing. I see it like an onion. Is this layers and layers? But it's still one thing. And how do we engage that? When I saw dealing with the age population, even as a research nurse, I was asking questions way back then, Wow. Pro days inhibitors and helping people to live long. Are we ready to take care of people that are gonna live a long time? So I asked question, and I started plowing because that was my interest. But there's a lot that we could do take advantage of being trusted in move forward. Okay, so you know, one of the things that we often hear and I I witnessed it is Well, you know, we did a lot with the affordable care act in terms of health insurance reform. But our health care system, as its structure we know still has quite a few, you know, embedded barrier. So you know, Dr Phillips, you seem to be on to something with your practice within this sort of broken health care system. So talk to us again. Ah, little bit, Maura. About what? You're doing with your practice in this system that nurses air really doing to help address and remove some of these barriers to your practice? Sure. So I will say, I don't know. I'm just I'm very well supported where I am. Um, so I am very thankful to have the opportunity to do these things. Um, and so because of that, I might be getting away with some things that maybe a lot of places can't get away with. But anyway, that's neither here nor there. One of the biggest things that we're doing is we're implementing HIV risk screening tool like I was talking about. And this is a huge game changer for making HIV prevention treatment sexual health apart of primary care because it forces the clinician to talk about sexual health and HIV because the questions are things that generally when you're in a diabetes or broken leg or high blood pressure visit, generally you're not bringing these things up. But now, as a part of every visit, when you first go in, we're asking Hey, are you having cotton list sex with more than one partner? Hey, are you sharing needles or any type of injection equipment with somebody of unknown HIV status. Hey, are you having sex? Um, in exchange for something that you need And hey, were you diagnosed with an STD the last six months? These are questions that people don't ask generally when it's like, what? But Dr Phil's What? What if I come and I say something to you like, Well, what? Dr. Phillips? I'm a minister. What are you talking about? Great question. Same thing with R P. H Q. We just have to normalize it. We have to say, Hey, just so you know, I'm gonna ask you some questions might feel a little uncomfortable, but these are questions that we ask everybody. Everybody, everybody e even the minister, even the master. You know what somebody once told me that a provider said no to their request for prep because they're a rural community. They're married, they have kids. And I mean, what would they need prep for, right? You know what's going on. You don't know anybody story. Maybe she's getting abused at home. Right way with this screening tool, you can't assume because somebody is a 70 something year old minister that they might not answer Yes, toe one of those questions. Okay, because over was it. 10% of people over age 55 is our newly diagnosed HIV populations. So you can make these assumptions. And that's why this screening tool is so important because it is catching those people that people are assuming. Oh, I'm not gonna talk with them about HIV, or I'm not gonna talk with them about sexual health. Right? Right. Well, you know what? Thank you for that. So I want to remind our audience listening that you're more than welcome to submit questions. Um, you know, we're looking for your questions this evening. Use the button below to submit those questions. We would love to answer them for you. What? We have such a great panel here this evening, but until you all start throwing me some questions, I'm going to continue chatting with these three wonderful experts that we have here. And so my next question is coming to you, Dr Lambert, because you know, you like me. You know, we've been in academia for a long time, you know? So we have that other hat. So we flash that statistic earlier that 80% of nurses are white. So what can nurses do? And those predominantly, you know, non black practice settings that are located in the majority black communities to really help a shift the conversation around HIV risk from behavior two toward an understanding of one's social determinants of health. A great question. So I think nurses, in order for nurses to change their practice, we need to make sure they have the information so they don't have the information. They can't change their practice. So if if they were taught or they believe that HIV risk is about a behavior, then that's how they're going to to drive the conversation. So we need to go back to educating our nurses, educate, making sure that they understand social terms of health. We're gonna have to educate those 80%. We're gonna have to educate those majority white nurses. Yes, we are. We're gonna have to educate them. And it goes to nursing schools, not just us as other nurses, but nursing schools, educating nurses about social terms of health. Um, you know, and sometimes as a nurse you have to do some self reflection in an attempt to assess your own biases, right? If you know that you don't look like the patient or the community that you serve. You need to do a self assessment, understand your own biases about members in the community that you serve, and then do the work yourself right to do some research to understand ways you can address. You're a good person. What do you mean? Okay, that that's great. You're a good person. But you still need to understand your personal biases so that you can treat your community. I understand we're all good people, but we all have our own biases that we need to address, and that helps us all. I mean, even as someone who looks like the community that I served, I may need to address some of my own personal biases so that I can be nonjudgmental and better treat my patients. I think I think that that's, you know, that that's a big deal. And then again, you know, why do we have you know, so many white nurses? Can we not go to the high schools and attract more black individuals to become nurses, male and female and then, you know, as the organization seek to diversify your staff? I think that's important. Well, as as you know, you know, the American Nursing Association just announced, you know, their initiation on the commission, uh, to look at racism and nursing. So I think we're going to get their doctor Lambert with Dr Grants work, uh, in and a, um you know, but, you know, going back Thio Dr. Phillips, You know, it sounds like you are really doing some things in that practice that is really helping toe address the stigma around, you know, things like sexual health. Uh, in your practice. Um, how would you go about training a cadre of our black nursing colleagues to do what you're doing? That's a great question. Well, I wanna be the coolest kid on the block, so I don't want anybody to do and I'm doing No, I'm just kidding. I would say the biggest thing is, find a mentor and then find, like, five more. Because the majority of what I'm doing right now, it was like 5% me 95% other people just and lift, uplifting me and saying, Hey, this is what you need to dio right now. Even me being in primary care right now. you know, I went to Duke for my masters and my doctor degree on did the HIV specialty and the number one thing that my advisor told me he was like, Do not work in I D and do not work in HIV clinic yet, he said, yet said, First you have to work in primary care because the energy and the drive that you have right now, you need to take that to primary care and change primary care practices to the point where a they realize if you don't have an infectious disease, you don't need to go to infectious disease, a k a. You don't need to goto i d for prep. You do need to understand when you should be testing your patients for HIV and what to do when it happens and how to not freak out about it. Those simple things many, many, many primary care settings do not have that, which is how I kind of ended up where I am here today. A lot of people just push me, nudged me and supported me, So definitely get a mentor. Other things are I highly recommend reading the literature and figuring out what's missing mhm and then trying to fill that void. Because the only reason I came in the situation of training primary care providers on prep starting in HIV prevention program was by reading the literature and realizing that that really is missing. And we really need to do that. We want to get down to the, you know, AIDS free generation, no new HIV infections. One day we do have toe make sure that we're having that fine tuned balance between making sure that everybody is getting treated and making sure that everybody at risk is having the appropriate prevention methods which starts here. Okay, Now remind me, are you in one of the full authority practice states? No. Isn't that the Christmas Party? I'm not well, actually kind of in terms of California was recently given full practice, but it is not started yet. So no, I really a lot of what I remember that you're you're in California. We'll have to We'll have to have a different webinar about a B 8 90 because I know what that Bill Waas adopted Phillips. Um but we have We have a great question from the audience. So the question at How can we better prepare? Um, our patients who are living with HIV to deal with health related stigma they often face in our health care system. So either Dr Lambert or Dr Phillips, you can answer that question. How do we better prepare the patient? I would say be riel like, Seriously, it just be real. Um, I mostly deal with HIV prevention side, but by the time clients get to me Ah, lot of the times, they're very, very frustrated because then referred to A and B and C and then their insurance at this. And now they're being referred to me, and it doesn't make sense again. This is something that should be done in primary care. Eso a lot of it. I think it's just being really letting them know. Hey, you might meet some frustrations along the way. You might have some stigma going on, just so you know, this is the safe space to talk about it. Bring that frustration to me. Let's talk about that together, and if that does happen, don't get mad. Don't freak out. I mean, you have all rights to be mad, but instead take that as an opportunity to educate the other person on the other side of that conversation so that you don't do that again. Okay? Okay. Miss Baker. You know, I was asking Dr Lamberg about What do we need to do with that with that was Kadre of of non divers, divers, nurses. So what? Types of training programs are available for the nurses through the A. T. C. Where? You know, I know you also do a significant amount of work that will help us address some of these issues we've been talking about. Absolutely so. One advantage with the A. T. C. And I'm in the mid Atlantic region and their regions there. Eight regions throughout the United States but in our region. And the purpose of the 80 C is make sure we're providing education about HIV on all levels. So recovering, not just HIV, the disease treatment, diagnosis, prevention, management, but we're talking about is well, health disparities in equities, cultural humility. Recover, prevention, prep. We talk about everything. Capacity building, whatever clinicians need. And it's for physicians, clinicians, nurse practitioners, pharmacists. We have the national HIV resource center, uh, with a T. C s and you can go online and click on any topic and you'll find something about it. We have the national HIV curriculum, which which is a module that people can take it several modules and you get CNN s for that seeing me for that, the same thing with the national hepatitis C curriculum. So there is a plethora of trainings and each region, uh, is providing these webinars. We also do them locally as well. So any topic there is no limit to what we can offer. We're pretty proud of the training that we do have, and we don't wait for our communities to reach out to us. You know, here we go after that clinic where you go after that community health center after that F Q h c. To see what their needs are because they may not know they need the training. Got it? Got it. Thank you for that is good to know that the training is out there, that we have people such as yourself that is really implementing yet, So we have another question from our audience. So the audience members asking what is the best way for nurses toe balance messaging off individual behavior change in the midst of acknowledging the social determinants of health. You know, racism and poverty and systems that oppress, um, on shape people's lives and nurse and, uh, nurses have toe work, toe address those things. Um, and they further action alot. We have to find a way to help people with behavior changes, which are so hard, even without systemic barriers. Uh, so I think what that really asking is Oh, how do we help truly help those nurses with that messaging around individual behavior change particularly, You know, uh, in the situation we're dealing with now eso crystal. Uh, Dr Lambert, you know you've done a lot of work with With with women. How would you answer that question? Um, I guess with regard Thio the women in addressing some of their barriers, I think it goes back Thio two nurses being a trusted profession. And on the individual level, um, me building a relationship with my patients so that we can talk about some of those individual behaviors. And I feel like if I build a relationship and I'm not and I'm nonjudgmental in our interactions, they're more likely to be open and to tell me about those behaviors. So then I can use that as a teachable moment to talk about the behavior. If I need to address the behavior, Um, and to link it back to the social terms of health, I think that's that could be incorporated into the discussion. So not only are we talking about behaviors, we're talking about things like racism, discrimination that may serve as as some of the barriers and how to address them. And, like for the last person and Dr Phillips address it. If you experience stigma or discrimination in healthcare setting, not only do you address it with that person, but you need to go above them, and you need to address it with the system because that needs to be addressed with everyone, not just that particular individual. They may not be the only person that needs to hear the message. So I think address it with them, but also go above them and let let the administrators know about the situation. You know, not the Phillips. You work with a lot of different patient populations as well. Um, what do you see? As you know, your number one sort of current challenge. Current challenge in what way? Uh, and and it's quest to really normalize it and reach those patients. Uh, that you talked about? What? You're what? You're a really nice model. Um, well, of course, you know, with the pandemic, the biggest challenge is having the opportunity Thio speak face to face. We very recently started implementing zoom calls to make our conversations a little bit more personable. Um, but definitely taking away that that wonderful factor of having the client here with you, um you know, it's it's not great, but in terms of implementing the screening tool, we don't really faces many barriers now. But I'm sure you can imagine what I had to go through to make that a system wide change. I mean, presentations on presentations on pilots on literature. It was not something quick. So of course, there are a million barriers around the you know, a lot. Um, Now, one of our biggest barriers with that that we're slowly overcoming is with our screening tool. We do have a pep and in pep, optional question where somebody says yes to prep. Okay, now we're gonna ask them. Has any of these things happen in the last 72 hours because maybe they might need and pack, right? That was one of our barriers. But now we're starting a protocol with our advice. Ners. Where if they do say yes, they have their whole protocol with. Okay, let's see if this candidate is appropriate for pep. And if so, we have them go to our immediate care. Or if I'm here that day, then they've seen me. Um, but that was definitely one of our biggest barriers at the time. Okay, Okay, so you know what? One of the things I and I really just wanted to acknowledge this because, you know, following up. What? What Miss Baker said about the training, You know, if we can better leverage, you know, things like this discussion tonight that's been sponsored by Gilead. You know, in collaboration with such a well known, trusted healthcare organizations such as the National Black Nurses Association, Um, I think really gives us a non opportunity for some additional educational topics in the future. Eso You know, I I know that our our friends at Gilead are listening Eso You know, I say they have to bring us back again. Uh, that's that. That's my plug for that. Um, but one of our students, uh, watches this saying, you know, how can, uh, new researchers collaborate with those already doing the work to truly make a difference? So again, in that research space, um uh, talk to me about that research space. Uh, 11 more time, Dr Lambert. So, for for that person, um, if you're interested in doing research, reach out to us. They I mean, we are. I know for me, I'm open your email. You can email him and I tell people, Listen, I'm human. I'm busy as well. If I don't respond, you're not bothering me. Email me again and say, Hey, I'm really interested in your work. Let's let's have a zoom meeting. And when we could meet in person again, let's go for coffee or if we had a conference, Let's meet. Um I'm willing to share my research. I'm willing to answer any questions because there is so much work to be done. We need more researchers. And if you are a researcher of color, we really need you and your ideas, right? I tell my students, my doctoral students and people interested in research it if you want to talk to Dr Fields, you start that email by going. I read your article entitled. You know, that's a really good way to stroke a research is ego. Uh, you'll probably get a quicker response because, you know, I'm like, you're one of those five people who read that article. That's good. Um um, okay, then that's a little modest. We read your work. I actually really do appreciate that. Um, so, you know, we're coming up to the end of our time on that really needed to be our last question. Um, so I want Thio. We're going to transition to some closing remarks. Eso very quickly. The one thing one last thing you wanna leave our audience, Miss Baker with very quickly, I'm going to make it as quick as I can. And that is from the community perspective. Be creative in reaching the populations that need to be reached. And one quick thing that I didn't get a chance to say and through my Internet drop. But we have been creative with reaching out to older adults to get tested as well by having testing for Turkey's where it's just not an HIV thing. we do health fairs and all kinds of educational things around that issue. Being creative, too. Use those national HIV awareness days like the one the national HIV and aging of. We have got done a lot of work with that and also be creative with letting your own physicians know whether or not that they're doing a sexual history on you or your family member asked them to have you done a sexual history. When you have your G Y n exam, do you have a doctor that's asking you more than just your pap smear or your prostate? It's It's a whole lot. Nurses can dio I'll stop there. Okay, What would you like to leave? Leave us with? Uh um I would say we need more people that look like us in this field. So, please, when you finally do decide to join the dark side, like coming into HIV and sexual health and all of this, please make it well known wherever you are that you are the sexual health champion of your health center on the website. When you're talking to the staff, like literally, I'd be like, Hi, My name is Dr Shockey Phillips and I'm like, Oh, my gosh, you're the HIV hep C girl. I'm like, Yes, I am questions, please. Because our patients need to know that you're there and staff when they have questions, they need to know that you're there to very good last word, Dr Lambert. Okay, So for those of us who want to do the work to improve health care outcomes for those from treatment Thio from from from prevention to treatment, um, make sure that we include the patients, those living with HIV, those at risk or in communities at risk, make sure that you ask them what they need and include them in your research, in your practice and in your strategies, they know what they need. Thank you for that. And I will simply say I agree with everything everyone said, but I want to really stress that we need you, uh, to come and be a part of the nursing revolution. Uh, in the nursing workforce, there is a place for you in this workforce. Um, I really want to thank all three of you for your time this evening. Um, it has been a wonderful conversation on Guy will then turn this presentation. Um, and for you all who out there who listened? Um, thank you so much. Um, so I really want to know if returning it back over to our, uh, wonderful sponsors for some closing remarks. Okay. All right. Um, so on that note, then I believe we we will bring this, uh, wonderful conversation to an end again. Thank you for my three wonderful colleagues. Thank you, Gilead Sciences for the partnership with the National Black Nurses Association. We truly do appreciate it. Um, I hope that we get a chance to do it again for all of you out there. Um be safe. Continue to do what you need to dio. Um I know we would like to do these things in person, and we we will meet again in person someday, but for now, we'll do our best through the virtual world on that note. Good evening. Have a pleasant night Created by
