Cultural Competency, Collaboration, and Conversation
Developing culturally competent approaches to engage hard-to-reach populations vulnerable to HIV infection in care remains a paramount concern for Ryan White providers. More than 50,000 new infections occur every year, most of them among young people under the age of 30 and in communities of color.35 Racial and ethnic minorities account for over one-half of the people who have died of AIDS since 1981, and represent approximately three-fourths of the almost 1.2 million people living with HIV in the United States today.36 More than fifty percent of those living with HIV/AIDS—approximately 530,000 people every year—depend upon Ryan White HIV/AIDS Program providers and grantees for life saving care. As Bradley-Springer notes,
The AIDS epidemic has taught us that anyone can be infected with HIV; but HIV has not been an equal opportunity infection. We have seen groups of people that have been more highly and disproportionately impacted—including African-American/Blacks, Native American and Alaska Natives, Asian and Pacific Islanders, Latinos, substance drug users, and sexual minorities.
Providers learned during the early years of the epidemic that they needed to be nimble and responsive to the ever changing HIV epidemic. For instance, the care models developed for HIV-positive gay men did not readily translate to people of color or women living with AIDS. The circumstances of their infection and access to health care services often were vastly different, requiring targeted approaches to care that reflected their unique needs.
Ryan White HIV/AIDS Program officials and providers have learned a great deal from consumers themselves, through their participation in community planning groups, planning councils, advisory boards, and other consortia. Based on their input, providers often hire staff that reflect the cultural, linguistic, and ethnic backgrounds of clients, from the front desk person who checks clients in, to the health care navigator who helps them track appointments, to the doctor who assesses their health.37
Once recruited, providers often drill down to the diverse needs of individual patients, connecting them with a continuum of care that includes health and social specialists who can address the spectrum of their needs, including diabetes, heart disease, homelessness, and malnutrition, among others. Studies speak to the success of this approach, showing that HIV patients from marginalized communities, including women and patients of color, often receive more targeted, appropriate care at Ryan White facilities than they would at their non-Ryan White counterparts.38
Putting Together the Pieces of the Puzzle: The Parts of the Ryan White HIV/AIDS Program
Efforts to create culturally competent health settings and approaches to care are supported across all parts of the Ryan White HIV/AIDS Program, including Part A, which funds that original “patchwork network” of core medical services delivering HIV care in communities and cities heavily impacted by HIV.39,40 Part B (previously Title II) includes the AIDS Drug Assistance Program (ADAP) which increases access to life-saving highly active antiretroviral therapy (also known as HAART) to people living with HIV disease.41,42