ADAPs and Minorities: Issues in Access

1. ADAPs and Minorities: Issues in Access Stephen Jackson, M.P.H. Nebraska Department of Health & Human Services Ryan White Part B Program Manager

2. Defining the Issues • Minorities are disproportionately impacted by HIV/AIDS • Minorities are underrepresented in ADAP numbers NASTAD Annual TA Meeting 7/09

3. CDC Data By Race/Ethnicity, 2007 NASTAD Annual TA Meeting 7/09

4. 2009 National ADAP Monitoring Report* NASTAD Annual TA Meeting 7/09

5. Nebraska Comparison Data NASTAD Annual TA Meeting 7/09

6. Nebraska Unmet Need Data, 2008 NASTAD Annual TA Meeting 7/09

7. Homelessness Transportation Stigma Acceptance of diagnosis Late access to care Acceptance of care Poverty Unemployment Disparate healthcare Incarceration Waiting lists Risk behaviors Apathy Population specific Testing Secondary Issues to Access – NASTAD Survey of States NASTAD Annual TA Meeting 7/09

8. Member States Comments • Los Angeles, CA: • Lower income, assumedly Medicaid eligible • Late testers • Washington DC: • Late access • Intermittent access • New Jersey: • AA men underrepresented in ADAP • Hispanics overrepresented in ADAP NASTAD Annual TA Meeting 7/09

9. Housing issue with Nebraska ADAP Clients • Homelessness • African Americans reported 2.3% non-permanent housing to ADAP (total pop) • African Americans non-permanent housing 8.9% within the population NASTAD Annual TA Meeting 7/09

10. Secondary Issues to Access – Nebraska ADAP • General Assistance • Veteran’s Administration • Focus group of AA men • 37.5% reported VA is their primary source of HIV care NASTAD Annual TA Meeting 7/09

11. Income Levels of Nebraska ADAP Consumers NASTAD Annual TA Meeting 7/09

12. Race Troubles: Why Do African Americans Fare Worse (Achieve) • Fight to stay off streets • Fight to stay sober • Poverty • Interpersonal relationships • Distrust of providers • Inadequate health insurance • Racial discrimination NASTAD Annual TA Meeting 7/09

13. Medical issues Higher infection rates Didn’t reach treatment goals Co-morbidities Liver disease Hepatitis C Less likely to receive treatment More likely to change providers More likely to disrupt treatment More likely to hide diagnosis Greater number of hospitalizations Late testing Late access Dual diagnosis Race Troubles (continued) NASTAD Annual TA Meeting 7/09

14. Medicaid/Medicare Private insurance County General Assistance programs Hospital Patient Assistance VA Emergency room access CHIP (high risk insurance pools) Self pay No access Alternate Points of Care NASTAD Annual TA Meeting 7/09

15. Effective Ways of Consumer Access to ADAP • Collaboration with ASO/CBO/external case management • FQHC • Family planning/family health • Local health departments • Referrals from out-of-network providers • Outreach funded through RW Part B • Peer states connecting consumers • Self referral NASTAD Annual TA Meeting 7/09

16. References • www.cdc.gov • 2009 National ADAP Monitoring Report • NASTAD Member States Survey • University of Nebraska Medical Center ADAP • Achieve, Spring 2009, pp 1, 3-4, 7 Race Troubles: Why Do African Americans with HIV Fare Worse?. Acria/GMHC NASTAD Annual TA Meeting 7/09

17. Stephen G. Jackson, MPH 301 Centennial Mall South, 3rd Floor Lincoln NE 68509-5026 402.471.2504 402.742.8328 FAX Steve.jackson@nebraska.gov NASTAD Annual TA Meeting 7/09