Combating cultural AIDS stigma 

click to enlarge Michaela Hoffman, HIV services director at the Mission Neighborhood Health Center, says her bilingual, multicultural staff strives to reach underserved minority populations. - GODOFREDO VASQUEZ/SPECIAL TO THE S.F. EXAMINER
  • Godofredo Vasquez/Special to The S.F. Examiner
  • Michaela Hoffman, HIV services director at the Mission Neighborhood Health Center, says her bilingual, multicultural staff strives to reach underserved minority populations.

The disparities in the number of men testing positive for HIV and AIDS in minority communities has long been known to researchers. The challenge is in getting them into testing facilities and then treated.

Men who have sex with men still make up the majority of infected patients, but there also have been steady increases and jarring discrepancies in cases among minority populations, said Dr. Veronica Miller, executive director of the Forum for Collaborative HIV Research. In the black community, for example, there has been a 48 percent increase in HIV/AIDS cases, according to the HIV forum. And among Hispanic men, the rate of infection is three times higher than that of white men.

Michaela Hoffman, director of HIV services at the Mission Neighborhood Health Center, said some of the biggest obstacles to treating a minority population are the cultural barriers and stigma associated with AIDS. The clinic’s staff members, she said, do their best to support these men when they come in for tests.

“Education and the socio-economic status have a lot to do with the stigma,” Hoffman said. “But when our patients come in even to get tested, they’ve crossed a lot of those barriers.”

One man who crossed that barrier is Aurelio, who asked that his real name not be used to protect his identity. Aurelio found out he was HIV-positive in 2005. After having tested negative for years, he was confused, scared and concerned. He also worried about how and where he could receive care.

The Mexico native was visiting his partner in The City on a visa, and thus did not qualify for care. And knowing the stigmas in Mexico associated with the disease, Aurelio was unsure what kind of care to expect there. As a result, he decided to apply for asylum to avoid jeopardizing his travel status and risk not being able to come back.

“I did a little bit of research and I knew I couldn’t get this kind of help in Mexico,” Aurelio said. “The quality is not the same. And there is a cultural stigma.”

He was then referred to the Mission center’s HIV health service, Clinica Esperanza, or “hope clinic.” Aurelio is one of 400 HIV-positive patients who receive medical care at the clinic, along with other types of assistance.

Roughly 15,500 people are living with HIV or AIDS in The City, according to the most recent statistics from the Department of Public Health. Nationally, more than 50,000 new patients are diagnosed each year.

Last month, researchers, clinicians and national leaders in the fight against HIV met in The City for the first time to discuss the disease’s impact on minority communities. Instead of focusing on the numbers, the group decided to look at better outreach strategies — including between agencies.

Miller of the Forum for Collaborative HIV Research, which hosted the conference, said helping Bay Area counties communicate would help them coordinate key health strategies and information.

“There hasn’t been a whole lot of working together,” she said. “Funding is complex, but so is the geography of the Bay Area. But working together could provide more efficient use of resources.”

The conference was held at UC San Francisco’s Mission Bay campus. But the HIV/AIDS epidemic and treatment in Hispanic cultures also attracted international attention that same week when Mariela Castro, the daughter of Cuban President Raul Castro, received a special visa to come to the U.S. to attend another conference. Castro is a sex educator and advocate for LGBT rights, and she was hoping to learn new ways of addressing HIV/AIDS treatment that she could bring back to her country.

Hoffman said the majority of her clients at the Mission clinic are immigrants and therefore might lack English skills or otherwise be too afraid to come in.

“A lot of work is addressing barriers to care,” Hoffman said.

Her staff is bilingual and multicultural, which Hoffman says helps make patients from Latin America feel more at ease.

For Aurelio, the decision to get tested was not hard. He said the biggest obstacle now is revealing the disease to his parents.

“They know I’m gay,” Aurelio said. “But I haven’t told them my health status. When it comes time, I will be ready.”

S.F. scrambles to find new treatment funds

With thousands of new HIV or AIDS patients diagnosed each year, funding to treat the diseases is decreasing.

Last month in San Francisco, weeks after $8 million in federal funding was cut, Mayor Ed Lee announced a plan to provide $6.6 million to primary care programs. But that money is just a Band-Aid; another $10 million in federal funding is expected to be cut in the 2013-14 fiscal year.

Funding for HIV/AIDS clinics, research and care in San Francisco is a complex web overseen by the Department of Public Health.

Bill Bloom, director of HIV health services for The City, said federal funding had remained flat for several years, as the number of new patients grew. Unless The City can match similar cuts in future years, he said, care could be hurt.

“We put a lot of pride in what we’ve been able to do with the funding,” Bloom said. “But the funding doesn’t keep pace with the number of people becoming infected.”

Dr. Veronica Miller, executive director of the Forum for Collaborative HIV Research, said with more cuts planned, it’s important for multiple organizations to work together and share resources.

Miller said since California’s funding system also is so complex, learning how to work together now will better prepare health systems when national care mandates take effect in 2014.

“Since pre-existing conditions will be done away with, health care reform will be good news for everyone,” Miller said.

— Andrea Koskey

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