Positive
Women’s
Network-USA
October 8, 2013
For Audio: Dial-in#: 866.394.2346
Participant Code: 397 154 6368#
Agenda
1.
2.
3.
4.
Welcome & Introductions, 5min
PWN Explores Retention, 30min
Panel Discussion, 20min
Announcements, 5min
Michael Hager
in+care Campaign Manager
National Quality Center
New York, NY
michael@nationalqualitycenter.org
2
In the chat room,
Enter your:
1. name,
2. agency,
3. city/state, and
4. professional
role at agency
Welcome & Overview
 This Partners in+care webinar is offered as part of the
in+care Campaign.
 The in+care Campaign is a national effort to improve
retention in HIV care.
 Webinars are one of many Partners in+care activities
designed to engage people living with HIV/AIDS and their
allies in the in+care Campaign.
For more information: www.incarecampaign.org
3
Participation Guidelines
 This is a “public event.” If you have confidentiality
concerns:
 Your names appear on-line in the list of webinar registrants
-consider just listening to the audio or to viewing the webinar at a
later time, after it is posted at www.incarecampaign.org
 All webinars are recorded - do not use identifying information
when asking questions
For Audio: Dial-in#: 866.394.2346
4
Participant Code: 397 154 6368#
Participation Guidelines
 Actively participate and write your questions into the chat
area during the presentation; we will pause for
conversation during the webinar
 Do not put us on hold
 Mute your line if you are not speaking (press *6, to
unmute your line press #6)
 The slides and recording of this and other Partners in+care
webinars are available for playback and group
presentations at www.incarecampaign.org – “Resources” tab
For Audio: Dial-in#: 866.394.2346
5
Participant Code: 397 154 6368#
www.pwn-usa.org
Engaging and Retaining
Women Living with HIV
In Care
Naina Khanna
Executive Director
Positive Women’s Network – USA
Partners InCare Webinar
Oct 2013
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Overview
1.
2.
The cascade for women
Barriers and Challenges
a. Structural
b. Provider-Patient Interactions
a.
b.
c.
Trauma as a factor
Discrimination
Communication
c. Stigma-related
d. Trauma History
1.
What works? Innovations and success
2.
Introduction of Panelists
3.
Q&A
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The HIV Treatment Cascade Among
Women
85%
70%
41%
36%
26%
Diagnosed
Linked to Care
Retained in Care
SOURCE: CDC, Fact Sheet – HIV in the United States: The Stages of Care; July 2012.
Prescribed ART Virally Suppressed
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Factors impacting the Cascade
Structural Barriers
Stigma
•Cost (co-pays, etc)
•Transportation
•Housing
•Geography
•Family/work responsibilities
•Health system level factors – eg. lack of integrated services
•Access
•Cultural Norms & Social Desirability
•Internalized stigma
•External stigma
Engagement in Care
Provider -Patient Interactions
Trauma & Violence
•Communication
•Power dynamics in relationship
•Lack of provider expertise
•Cultural norms
•Healthcare or social service system as a retriggering/traumatiizing
environment
•Discrimination
•Health literacy
•Past and present
•Healthcare & social service system as retriggering environment
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Structural Barriers
 From an individual risk behavior model approach to a structural,
environmental and contextual approach
 It’s not just about behavior, before or after.
 Poverty is a predictor, but also a consequence of HIV
diagnosis.
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Structural Barriers
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“But I also know that this woman actually has control over what ultimately is a
life or death decision with the stroke of her pen. And clearly she is in a bad
mood… What I have is a very expensive medical condition and no way to pay
for it… it is that simple. I need help. We as women living with HIV are driven
into poverty and held there, and we are drowning.”
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
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Stigma-Related Barriers
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Provider-Patient Interactions
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Has any provider (doctor, nurse, case manager, or peer advocate)
ever told you that when your VL is undetectable, you are less
likely to pass HIV to an HIV-negative sexual partner?
N = 122
Source: PWN-USA SRHR Online Survey, August 2013
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Reproductive Health and Rights
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Trauma History
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Trauma History
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Trauma History
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A Way Forward
 From an individual risk behavior model approach to a structural,
environmental and contextual approach
 It’s not just about behavior, before or after.
 Change the context of women’s lives
 Change the way we address women’s care
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A Way Forward
Improve care and
service delivery
environments
Systemslevel/Structural
Care for
WLHIV
Building women’s skills
and self-efficacy
Address culture and
social environment
context
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What Works
Address lives of WLHIV
through interventions that
address our lives - eg resume
writing, job training,
employment preparedness,
trauma healing
Improve environment of care and
service delivery systems – eg traumainformed care, peer based services,
culturally relevant care, provider
expertise
Address context for WLHIV through systems-level
interventions – examples: policy change, integrated
services for MH, SA, SRH, & changing cultural norms
around HIV
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Expert Panel
Panelists:
Loren Jones
Oakland CA
Independent Policy Advisor
Diagnosed: 1985
Jay Conner
San Diego, CA
Peer Navigator, Christie’s Place
Diagnosed: 1996
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Questions?
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Thank you
Naina Khanna
Executive Director
Positive Women’s Network – USA
Naina.khanna.work@gmail.com
510.681.1169
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Partners in+care Resources
Visit Web / Open the Toolkit
www.incarecampaign.org - “Partners” tab
Sign up for Partners in+care Network
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Join Facebook
Send email to
incare@NationalQualityCenter.org –
“Facebook” in subject line
36
Campaign Headquarters:
National Quality Center (NQC)
90 Church Street, 13th floor
New York, NY 10007
Phone 212-417-4730