1. Influences of Cultural Contexts and, Clients’ and Providers’ Characteristics on Medical Care for Women with HIV/AIDSDonna B. Barnes, PhDCalifornia State University, East Baydonna.barnes@csueastbay.eduhttp://www.sci.csuhayward.edu/mbrsbridge/research.htm AIMS RESULTS RESULTS RESULTS • Providers’ Tensions • Between Beliefs & Practice • were influenced by: • DIFFERENTIAL SOCIAL CAPITAL • “I am frustrated that the women that I care for as patients have grown up with so few resources and with such major lack of support that they are so inadequately prepared to deal with chronic illness. And the truth is I don’t have resources to offer them to rebuild those. That’s not my job” (Caucasian female nurse practitioner, 22 yrs experience). • SOCIAL CONDITIONS • “I struggle with, what seems like my inability to help clients make long-term changes. Meeting the immediate needs is what we focus on. We’re not seeing the kind of change that we want to see. We want people to be able to experience home stability, financially and in relationships, with less depression, less anxiety and less crisis, less poverty, more economic opportunities that are real, safer communities to live in and less violence”(Caucasian female social worker, 4 yrs experience). SPIRITUAL BELIEFS “I think she [client] felt that God would take care of everything. But I suggested that she needed to be in therapy, in addition to her spirituality”(Caucasian female director/SW, 14 yrs experience). • What cultural contexts influence the counseling practices and beliefs of providers who care for women with HIV/AIDS? • How do workplace culture, client’s social conditions, and providers’ characteristics influence these practices within different service models? • How do POLICIES • Support or Undermine? • Recognition of Effect of Complexities of Clients’ Social Issues • “I think it’s incredibly important to be able to have ateam of people who you are close with and you trust and you can cry with sometimes” (Caucasian female case manager, 8 yrs experience). • Involvement in Decision-making Processes • “I’m not able to make decisions and yet, I have to enforce the decisions that I don’t always agree with. I become like a social worker slash compliance police” • (Caucasian female social worker, 11 yrs experience). • Mental Health Days/Time off Without Guilt “I think that we should have a way to take a mental health day. The administrative nurse passes out a little happy face if you’ve had perfect attendance. If you’ve missed three days a quarter, you get the little frownie face. It’s like, ‘Get a grip, woman!’ We’re dealing with a population that we need to be away from time to time, without being made to feel guilty”(African American female substance abuse counselor, 10 yrs experience). • Salary Reduction Effect • “Salary reduction makes it difficult to deal with patients. Maybe you’re a little bit more sharp, or you may not be as friendly” (Filipino male physician, 10 yrs experience). • Types of Providers Workplace Culture: Lack of Dialogue About Tensions Helpfulness of Staff Meetings in Reducing Stress METHODS • Providers (n = 55) • Oakland, California (n=28) • Rochester, New York (n=27) • Panel Study Design • Two face-to-face 90 minute interviews • 12 month intervals between 2001-2005 • n = 107 interviews • Recruitment • Targeted and chain-referral sampling • 22 agencies • $50 honorarium offered • Data Analysis • Grounded theory qualitative& • Quantitative SPSS methods Results did not change significantly from Time 1 to Time 2 The providers’ answers are significantly correlated (p<0.001) for the two time periods*. Helpfulness of Unscheduled Meetings in Reducing Stress Results did not change significantly from Time 1 to Time 2. The providers ’answers are significantly correlated (p<0.001) for the two time periods*. CONCLUSIONS A participant referred to unscheduled conversations as“Curbsides!”described as“Pull over here quick & let’s just have a chat. ‘Whatdday think? Or ‘Let me blow off steam here,’ or ‘Do you think so too,’ and ‘Can you help me with this”(Caucasian female therapist, 4 yrs experience). • Providers’ perspectives • offer direction for • Counseling practices • Areas of staff support • Supportive workplace culture for dialogue • Resource allocations • Potentially optimizing women’s continued HIV/AIDS care. HEALTH CARE “I’ve got plenty of people with an undetectable viral load and a t-cell count of six hundred who still are just so in need of help on other levels outside of their HIV status. You can’t just see how someone’s doing on paper and say, ‘Their labs are stable so they must be doing well.’ Meanwhile, their life might be falling apart in another way” (Caucasian female nurse, 8 yrs experience). RESULTS Helpfulness of Social Support in Reducing Stress Providers Demographics “My personal feeling about substance abuse is that it is a cultural thing. It is a huge, deep, ugly problem in our country that no one is dealing with. I feel like what we’re doing now, with the counseling, is just scratching the surface. Why is our culture so drug-oriented? And until we address it on that level, I think we’re always going to be caught in this frustration”(African American female physician, 7 yrs experience). ACKNOWLEGEMENTS Results did not change significantly from Time 1 to Time 2. The providers’ answers are significantly correlated (p<0.001) for the two time periods*. Sheigla Murphy, PhD - Susan Taylor-Brown, PhD -Beatrice Morris, MDiv - Monica Bill Barnes, MFA - Nancy Prowell, BS, RN - Craig Sellers, MS, APRN-BC - Lyn Blackburn, MSW- Parul Baxi, MA -Audrey Alforque Thomas, MA- Tim Smith, BS, and The Providers. Mean Age = 45 at Time 1 *Percentages may not equal to 100 due to rounding Presented at the XVI International AIDS Conference,Toronto 2006 THPE0795. This research is funded by: National Institutes of Health - Grant 2 S06 GM 48135