Bienestar Human Services, Inc.

1. Bienestar Human Services, Inc. Education, Empowerment, and Mobilization… Our Community’s Solution!

2. Presentation Overview • Organization overview • Current data and research on Latino/as • Bienestar HIV Counseling, Testing and Referral Program and Testing Outcomes • Program Challenges and Solutions

3. Bienestar is committed to enhancing the health and the well-being of the Latino community and other underserved communities. Bienestar accomplish this through community education, prevention, mobilization, advocacy and the provision of direct social support services.

4. History • Established in 1989, as a direct result of neglect of services for Gay & Bisexual Latino men. • Began with a $10,000 grant from the United States Conference of Mayors. • Grass-roots, community-based organization offering culturally competent, sensitive and linguistically appropriate social services. • Bienestar has evolved into a multi-service and multi-center agency, with annual expenditures in the range of 5.5 millions dollars.

5. Locations • Ten centers located throughout three Counties in Southern California: Los Angeles, San Bernardino, and San Diego. • Has allowed us to create a web of easily accessible services within geographic areas of highly concentrated Latino/a populations.

6. Centers San Diego La Casa – Gay & Lesbian Center Headquarters - East LA El Monte Hollywood Long Beach South LA San Bernardino Pomona Van Nuys

7. Programs and Services Offered: • Social Support: Case Managment Housing Services Mental Heatlh Treatment Adherence Counseling &Education Food and Nutrition Counseling Peer Support • Prevention Education: Effective Behavorial Interventions HIV and STD Counseling and Testing Harm Reduction Activities

8. Community Transformations “From the depth of need and despair, people can work together, can organize themselves to solve their own problems and fill their own needs with dignity and strength.” -César E. Chávez

9. Client and Staff Demographics • Client base served by Bienestar range from the recently immigrated, to the acculturated, who have been traditionally underserved, indigent and disenfranchised. • The staff and peer volunteers are bilingual and share a genuine concern of providing its clientele with culturally competent and appropriate information and services. Over 99% direct service delivery staff is Latino. • Has fostered our ability for over 16 years to remain client centered, resulting in sustained community trust.

10. National, State and Local County HIV Surveillance Data Across the nation: • Although Latinos represent approximately 14% of the U.S. population, they account for approximately 20% of all AIDS cases diagnosed since the start of the epidemic. • Knowledge of HIV status among those already infected is very low.

11. National, State and Local County HIV Surveillance Data California through December 2004: • Distribution of all AIDS cases by Race/Ethnicity- 22% Latino. • As of July 2005, there were over 25,000 Latinos living with HIV and AIDS. Los Angeles County: • The magnitude of AIDS cases among Latinos is higher than in other parts of the United States, with 47 percent of new AIDS cases being Latino.

12. Access to and Use of the Health Care System • The HIV Cost and Services Utilization Study (HCSUS), the only nationally representative study of people with HIV/AIDS receiving regular or ongoing medical care for HIV infection, found that Latinos fared more poorly on several important measures of access and quality. • In addition, HCSUS found that Latinos were more likely to report postponing medical care due to factors such as lack of transportation and language barriers. • Traditionally, Latinos have viewed access to health care as a not part of the norm.

13. Access to and Use of the Health Care System • CDC data indicate that Latinos diagnosed with HIV may be more likely to be tested late in their illness—that is, diagnosed with AIDS within one year of testing positive. • Over a third (43%) of Latinos who tested positive in the 33 areas with HIV reporting received an AIDS diagnosis within one year, compared to 38% of African Americans and whites.

14. Types of HIV Testing Offered 10 year history of offering HIV Counseling, Testing and Referral to historically disenfranchised Latinos who do not regularly access health care. • Commenced in the mid 90’s via blood draw in collaboration with community based clinics. • Late 90’s and early 2000’s transitioned to Orasure. • 2003 commenced offering Oraquick. • 2005 commenced offering Oraquick Advance.

15. HIV Counseling, Testing and Referral Program • Client centered direct HIV Counseling, Testing is offered at Bienestar satellite centers and ATS in Los Angeles County. • Aim is to offer HIV testing to high risk individuals of unknown seropositivity status through a ethnographic strategic plan.

16. HIV Counseling, Testing and Referral Program Models of HIV testing offered: (Vary depending on targeted behavioral risk group and venue). • Storefront Community Based Testing • Offer through out EBI intervention to a well informed, consenting, HIV at high risk captured audience (See example). * Mobile Community Based Testing • Public health fairs, pride festivals, bath houses, night clubs, “shooting galleries”, etc… • LA STD Dept. in conjunction with HIV Testing

17. Program SOW compliance Formative Evaluations Focus Groups Risk Assessment Referrals HCTR.. Behavior Modification Contract Referrals HCTR. Desired HIV and Substance Abuse prevention Behavior 30 day Follow-up session Social Marketing Campaign Client Outreach/ Recruitment Intake Assessment Voices/Voces Group Level Intervention Behavior Modification Contract Session 1 HCTR Referrals Voices/Voces DEBI fidelity and quality assurance compliance Session 2 Risk Assessment Social Marketing Evaluation Survey Session 3 Pre-Post test Behavior Modification Contract Fidelity and Quality Assurance Checklist/Tools VOICES/VOCES Program Flow Chart Incorporating HCTR

18. CDC Rapid Testing HIV Counseling, Testing and Referral 2004-2005 Program Outcomes

19. HIV Counseling, Testing and Referral 2004-2005 Outcomes (Continued)

20. HIV Counseling, Testing and Referral 2004-2005 Outcomes (Continued)

21. Program Challenges and Solutions: • Challenge: Obtaining CLIA waiver. • Solution: Worked with various instituitions in securing a Physcian interested in working the organization (e.g. PAETC). Also allocated resources into program budget to cover related expenses. • Challenge: Frequency of HCT&R Training and Certification Courses offered by the State- Offered locally a couple of times a year. • Solution: Work closely with local health department in reserving space for staff to be trained.

22. Cultural Competent and Linguistically Appropriate • Stigma, discrimination, shape and fear drive people underground and make prevention harder for everyone. • Particularly for disenfranchised communities. -Latino migrant workers engaging in sex with other men and women (MSM/W) for survival as noted in recent studies- CA. UARP-Drew, LA EPI. • Programs must function with an acute understanding of the centrality of these issues in the experience of people at risk or living with HIV/AIDS, and must help people cope with their impact.

23. Cultural Competent and Linguistically Appropriate • Addressing community challenges amongst the highest risk as noted in the works of Dr. Rafael Diaz. • Loneliness/isolation • Low self esteem • Financial stress • Fatalism • Racism • Homophobia

24. Partnering with Healthcare Facilities to Overcome Healthcare Challenges • Work with several local health clinics in providing services (e.g. LA USC 5p21, AIDS Healthcare Foundation). • Provide vital ancillary support services (whether negative or positive HIV outcomes) to ensure that no one falls through the system. • Literature supports this form of collaboration- CDC 2005 Interim HIV Testing Guidelines.

25. Bienestar Familia Noe Zuniga V.P. of Programs and Services 5326 E. Beverly Blvd. Los Angeles, Ca. 90022 323) 727-7896 323) 727-7985 nzuniga@bienestar.org