IHS Tackles HIV Issues with Online Training and New Initiatives

by U.S. Medicine

December 14, 2010

WASHINGTON, DC—Providers play an important role in HIV prevention and care, and IHS is hoping to help providers carry out that role through online training that was developed last year.

IHS in collaboration with community members and Native American healers developed an online training module for providers that covers HIV information relevant to serving the American Indian/Alaska Native (AI/AN) community. “The online format was utilized to meet the need for increased geographic reach to remote or rural areas and to maximize limited resources and training flexibility. A provider or community member can access this at their own convenience and desired level of privacy,” said Rear Adm Scott Giberson, the national HIV/AIDS principal consultant for the IHS, in an e-mail interview.

The training provides tracks on stigma related to HIV and HIV testing; HIV testing and the healthcare provider; motivational interviewing; risk assessment; and traditional or cultural practices in care.

The training on traditional practices in care was important to include since traditional practitioners often play a role in care for AI/ANs, Giberson noted. “The depth and type of involvement may depend on the patient’s preferences, location, or whether a practitioner is available. However, there have been many instances of traditional healers partnering with the IHS to improve patient outcomes.”

A section is also included in the training that is designed to provide a basic understanding to those with HIV and other community members about HIV infection, testing, treatments, and what it means to live with HIV.

Addressing HIV Among AI/AN

Tackling HIV among AI/ANs has been a concern to HIV activists. Even though the numbers of HIV and AIDS diagnoses for AI/ANs represent less than 1% of the total number of HIV/AIDS cases reported to CDC, when population size is taken into account, AI/ANs ranked third in rates of HIV/AIDS diagnosis in 2005.

In 2006, as a way to increase the number of all individuals tested for HIV in the US, CDC released new recommendations that urged providers to include HIV testing as a routine part of their patients’ healthcare, which had not previously been done. By increasing the number of people who are aware of their HIV status, it is hoped the spread of the disease can be reduced.

CDC and IHS began collaboration that year to fully support and attempt to implement the recommendations, according to Giberson. He said that HIV testing in general has increased in IHS over the last 10 years. “Between 2005 and 2009, documented prenatal HIV testing rose from 54% to 80%. Overall, more ‘universal’ HIV testing has steadily increased over the last 10 years. In total, more than 65,000 screenings were reported in 2010, an increase of more than 500% since 2000.”

Still, Giberson acknowledged that implementing CDC’s 2006 recommendations is not without its challenges in the IHS system. The most persistent challenges include competing priorities of the healthcare system, he noted. “This may translate to local-level capacity to address HIV, or a need to focus on other care priorities for providers’ resources, time, and attention. The local champions who coordinate the enhanced HIV services already have full-time responsibilities that may have nothing to do with HIV.”

New or Expanded HIV Initiatives Planned

IHS has several new or expanded HIV initiatives planned for 2011, according to Giberson. These initiatives are focused around community-level prevention interventions, HIV screening, and clinical services enhancements.

In terms of community-level interventions, Giberson said IHS will work with community-based organizations on material and HIV interventions targeting younger age groups. “The tools developed will be designed to delay sexual initiation,
reduce number of sexual partners, and increase STD/HIV testing. This will include clinic locator tools and be integrated with planning for overall screening expansions.”

In terms of HIV screening, IHS plans to maintain at least 40 screening sites, including tribes and tribal organizations, as part of a comprehensive public health prevention intervention. The goal will be continued growth in the number of participating sites.

Giberson said IHS will also continue to improve direct medical services in a variety of settings. This will include new training to address HIV and co-occurring infections such as hepatitis C, coordinated services in urban areas highly impacted by HIV, and increased use of the HIV telehealth network. “The telehealth network can be used to improve the number of available providers in remote, historically underserved communities and to improve health outcomes through multidisciplinary teams.”

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