PRINCIPLES OF ORAL HEALTH MANAGEMENT FOR THE HIV/AIDS PATIENT CULTURAL COMPETENCY

1. PRINCIPLES OF ORAL HEALTH MANAGEMENT FOR THE HIV/AIDS PATIENTCULTURAL COMPETENCY Elias J. Llerandi, DMD Clinical Instructor, NY Medical College Consultant, NYS Dept. of Health Staff Dentist, Dept. of V.A. Private Practice, Queens Former Chief of Service, Spellman Dental Clinic, SVMH

2. OBJECTIVES • Define and Recognize fundamental characteristics of Culture • Identify components of the process of Cultural Competence • Discuss the importance of understanding cultural variation in the dental clinical setting and how it influences our Tx plan and its implementation

3. CULTURE • What is it? …acting, feeling, judging, perceiving, and organizing (Shade, Kelly and Oberg, 1997) • Why is it important? -facilitates tx plans that can be followed by pts and supported by their families -enhances communication and clinical interaction -helps Bottom line: Leads to retention of pts in a competitive environment ($$$)

4. Learned Behavior Shared Ever-changing No culture is better of worst than another, they are just different CHARACTERISTICS OF CULTURE

5. A SET OF CONGRUENT BEHAVIORS, ATTITUDES AND POLICIES THAT COME TOGETHER IN A SYSTEM, AGENCY OR AMONG PROFFESIONALS AND ENABLE THAT GROUP TO WORK EFFECTIVELY IN CROSS-CULTURAL SITUATIONS CULTURAL COMPETENCY

6. Racial & Ethnic Minorities Women Substance Abusers Gay/Lesbian/Bi-sexual/Transgender MSM SPECIAL POPULATIONS IN HIV

7. Disproportionate Incidence of New Cases of HIV/AIDS in People of Color in 2002 New HIV Cases (n=40,000) Total US Population (n=288,369,000) 54% Cases (%) White* 69% 26% 19% Black* White* Hispanic New AIDS Cases (n=42,024) 50.4% 5% 12% 13% Cases (%) Other 28.4% Black* Hispanic 19.6% *Not Hispanic. CDC: HIV/AIDS Surveillance Report. 12/2003. Black* White* Hispanic

8. Communication: Verbal, non-verbal, silence, eye contact Space: Degree of comfort, perception of space Social Organization: church, family Time: latinos/substance abusers Environmental controls: ‘I am undetectable’ CULTURAL VARIATIONS

11. Communication: Verbal, non-verbal, silence, eye contact Space: Degree of comfort, perception of space Social Organization: church, family Time: latinos/substance abusers Environmental controls: ‘I am undetectable’ CULTURAL VARIATIONS

14. Individual Pt-Provider & System Level Culture influences help seeking behavior and attitudes toward HCP Communication must be clear Pt has personal experiences of biases within the healthcare system HCP from culturally and linguistically diverse groups are under represented Incorporating Culture into Health

17. Alcohol Ether (starting fluid) Benzene Paint thinner Freon Acetone Camp stove fuel Ammonia Red Phosphorous Toluene (brake cleaner) Red Devil Lye Drain cleaner Battery Acid Lithium from batteries Ephedrine Cold tablets Diet aids Energy boosters Recipe for Disaster

24. Health Literacy

25. HCP are reluctant to offer Tx plan option to pts they believe will be non-compliant MDs are more likely to Rx HAART to those perceived to be likely to be adherent MDs were more likely to tx African Americans as non-adherent ( Bogart et al.,2001) Do not limit tx plan choices based on assumptions about a cultural group… POTENTIAL FAILURES!!!

29. 40-80% OF MEDICAL INFORMATION IS IMMEDIATELY FORGOTTEN HALF IS REMEMBERED INCORRECTLY THE MORE GIVEN, THE MORE FORGOTTEN SPEAKING INFO-17% SPEAK AND SHOW-84% PT-HCP COMMUNICATION CHALLENGES

34. Cultural Awareness: Front desk appreciates/respects values and problem solving strategies Cultural Knowledge: Seeking/obtaining factual info on different cultures…’TWO MASK JOB’… Cultural Skill: Collect relevant data about health hx/problems latinos HIV is taboo/’DL’ in aa PROCESS OF CULTURAL COMPETENCE

35. Cultural Destructiveness: misinforming pt of medical risks and benefits e.g.: LA Co. DHS measles study, sargenti Cultural Blindness: color or culture makes no difference , all people are the same OR making services so ethno centric as to render them useless to other cultures FROM DESTRUCTIVENESS TO PROFICINECY

36. Cultural Pre-Competence: hire staff that reflects different cultures Training Needs assessments Recruit diverse individuals to advisory committees FROM DESTRUCTIVENESS TO PROFICINECY

37. Cultural Competence: Respect for difference Continue self-assessment Continue expansion Adapt FROM DESTRUCTIVENESS TO PROFICINECY

38. Cultural Proficiency: Hold culture in high esteem Close cultural gaps and improve service delivery Positive tx outcome Minimize oral disease with systemic consequences Improve quality of life FROM DESTRUCTIVENESS TO PROFICINECY

39. 63.8% of new AIDS cases in men (3/5) 81.9% of new AIDS cases in women (4/5) 85.6% of new AIDS cases in children (4/5) Latinos receive an AIDS diagnosis at early ages(<30yrs old) MINORITIES AND HIV

42. Latinos have different perception of time, more flexible understanding of punctuality Saving time less important than a warm relationship. May see as rudeness a hurried pace or focus on saving time LATINOS AND HIV

43. Bigender, MTF, FTM Identities change Hormones and Surgery Transgender=Gay TRANSGENDER (LGBT)

44. The Office: ‘Scan’ Train staff Forms Unisex bathroom Non discrimination policy poster visibly TRANSGENDER (LGBT)

45. Become familiar w/ pts culture Respect pt’s desires Modify teaching as necessary Involve family/significant other DO NOT BE JUDGEMENTAL HOW CAN WE BE EFFECTIVE