Reflections on Outcomes Achieved:

1. Reflections on Outcomes Achieved: Your Work; Your Successes!

2. June 10 – 23, 2000 • HAETC staff visited • American Samoa • CNMI • FSM • Guam • Palau • RMI • To understand HIV/AIDS in the Northern Pacific

4. The HAETC Team Learned • Diabetes, • Hypertension, • Coronary heart disease, • TB • Demanded most of the medical and public health resources • However…

5. Guam and CNMI

6. Pohnpei and Yap

7. Had active HIV positive patients at that time. • Health professionals were eager to: • Prevent new infections • And care for HIV positive patients

8. Throughout The Region • There was interest in • Developing laws regarding HIV disease, • Establishing hospital and outpatient policies/procedures, • Reviewing confidentiality issues • Understanding/acquiring meds for • PEP, • Pregnant women, • and OI

11. Guam in June 2000 • Guam had the largest number of HIV/AIDS cases in the US Pacific Islands. • 135 cases: • 23 people living with AIDS; • 73 known to be living with HIV; • 38 deaths due to HIV

12. Guam in June 2000 • First pediatric case in 2000 was a child < 5 • Chamorros and Micronesians comprised the majority of HIV cases

14. CNMI in June 2000 • Saipan reported 29 HIV positive people • 2 perinatal cases • 5 people living with AIDS. • There were an estimated 300 infected with HIV • There was one HIV positive man in Saipan who visited most of the jurisdictions speaking about HIV. He made a positive impact

16. Palau in June 2000 • There were two known cases of HIV in Palau – both were deceased • No known HIV+ people living in Palau at that time. • Testing was offered to people with: • STD’s, • TB, • Blood donors, • People seeking physical exam, • Pregnant women

18. Yap in 2000 • Yap had two HIV+ people. • A man who worked and was infected off-island (and who died in 2000) • Infected a woman who became pregnant. • The woman was 30 years old, • It was her third pregnancy. • The baby was born and at the time of the visit, 3 months old.

19. Yap in 2000 • They found that the woman was HIV positive in prenatal screening in September 1999. • Yap routinely tested all • pregnant women, • alien workers, • students at physicals, • and any donated blood.

21. Pohnpei in 2000 • HIV testing had commenced in May 2000 • Testing was anonymous and required client consent. • HIV testing was offered • with premarital exams, • at student physicals, • to food handlers, • and to pregnant women. • Donated blood was not screened.

23. Kosrae in 2000 • No known HIV cases in Kosrae at that time. • It was reported that 13 years previously • a Kosraean man was diagnosed on the U.S. mainland, • And came home to Kosrae to die. • There was some social discomfort with this situation

25. Chuuk in 2000 • The team was unable to visit Chuuk at that time, • But met with representatives in Pohnpei. • There were 3 known HIV cases, • One person had come home to Chuuk to die,

27. RMI in 2000 • Doctors told the team that there had been 9 HIV cases among the Marshallese (excluding foreigners and military).

28. RMI in 2000 • 3 were diagnosed in California, • 3 in Guam, • and 3 in Hawaii. • None were presently in RMI. • HIV medications were not accessible, but the medical staff was enthusiastic about providing care

30. American Samoa in 2000 • There were no known HIV cases • There had been 6 cases of patients with end-stage AIDS -- all of who had died. • The most recent patient died in 1998. • There was an infrastructure for HIV/AIDS prevention • Fara Utu, RN, • Led a very active HIV/AIDS Program

31. Visit Ideas • Provide HIV information via clinical conferences, • To Jurisdiction-based clinicians • And support a network of region-wide HIV clinicians to share ideas about patient care, • You have built a network of clinicians and trainers spanning a vast area…

33. You have participated in six region-wide conferences in eight years

35. Visit Ideas, continued • Provide clinical assistance with PEACESAT conferencing to give clinicians access to any needed information

36. Visit Ideas, continued • Provide one-week mini-residencies for clinical care information

37. Your dedication has led to many successes since June 2000

38. In 2000 vs 2008 Written universal precautions protocol? American Samoa: CMNI: 2000 – No FSM; Chuuk: FSM; Kosrae: FSM; Pohnpei: 2008 – Yes FSM; Yap: Guam: Palau: RMI:

39. In 2000 vs 2008 Written testing/counseling protocol? American Samoa: CMNI: 2000 – No FSM; Chuuk: FSM; Kosrae: FSM; Pohnpei: 2008 – Yes FSM; Yap: Guam: Palau: RMI:

40. In 2000 vs 2008 Written perinatal protocol? American Samoa: CMNI: 2000 – No FSM; Chuuk: FSM; Kosrae: FSM; Pohnpei: 2008 – Yes FSM; Yap: Guam: Palau: RMI:

41. In 2000 vs 2008 Written PEP protocol? American Samoa: CMNI: 2000 – No FSM; Chuuk: FSM; Kosrae: FSM; Pohnpei: 2008 – Yes FSM; Yap: Guam: Palau: RMI:

42. In 2000 vs 2008 Best Practices HIV treatment information: American Samoa: CMNI: 2000 – No FSM; Chuuk: FSM; Kosrae: FSM; Pohnpei: 2008 – Yes FSM; Yap: Guam: Palau: RMI:

43. In 2000 vs 2008 Recognition of HIV Signs/Symptoms: American Samoa: 2000 – No, 2008 – Yes CMNI: 2000 – No, 2008 – Yes FSM; Chuuk: 2000 – No, 2008 – Yes FSM; Kosrae: 2000 – No, 2008 – Yes FSM; Pohnpei: 2000 – No, 2008 – Yes FSM; Yap: 2000 – No, 2008 – Yes Guam: 2000 – Yes, 2008 – Yes Palau: 2000 – No, 2008 – Yes RMI: 2000 – No, 2008 – Yes

44. In 2000 vs 2008 Regional HIV Trainers now available: CMNI: Dr. James Hofschneider FSM; Chuuk: Dr. Yoster Yichiro Eleanor Sos, RN, NP FSM; Pohnpei: Dr. Elizabeth Keller Nancy Lynn Edwards RN NP Mercedes Gilmete FSM; Yap: Dr. James Edilyong Palau: Dr. Selaima Lalabalavu RMI: Dr. Zachraias Zachraias Dr. Chocho Thein

45. Your hard work has given the Pacific a network of HIV care providers and trainers

46. Thank You! • We’re excited about the next steps. • But we’ll need your guidance over the next few days and next few months to help us understand your needs.