>> Marlene McNeese: Good morning, everyone,
and welcome and welcome back to day two of the 80th Presidential Advisory Council on
HIV AIDS, also known as PACHA. My name is Marlene McNeese. My pronouns are she and her, and I am one
of the co-chairs and I currently serve as deputy assistant director with the Houston
Health Department overseeing our Bureau of HIV, STI, and viral hepatitis prevention. For everyone in the room here today and those
watching online through the live stream at hiv.gov, ju
st welcome. I am full still today from the amazing days
that we have spent together here in my home city and I just have to say I am proud to
be a Texan today because of the amazing leadership and work from my fellow colleagues and advocates
who are serving their community in mighty and innovative ways, despite our challenging
environment, so I really, really just have to say thank you again and please help me
give my fellow Texans a round of applause. And we have yet another full day today, so
I won't be long before you this morning. I will turn it over to my co-chair, Dr. Vincent
Guilamo-Ramos, for his opening comments. >> Vincent Guilamo-Ramos: Good morning, everyone. It's wonderful to be back for the second day
of our formal meeting. The third day here in Houston, TX. I think Marlene, you have used the word full
a number of times and I'm just going to sort of borrow from that language. I think it's been quite an impactful meeting. There are a number of issues, I just want
to share,
last night as I was reflecting that are really sort of weighing heavily in my
mind, and I think that it's work that we as a committee should consider very seriously
pursuing. But first is that I heard lots about Medicaid
expansion and individuals in Texas and elsewhere that are not covered and have no way of being
able to access primary care and HIV care. There was quite a bit of discussion about
formularies and adapt and whether or not single tablet versus sort of multi tablet, certain
kinds o
f injectable medications etcetera, how are those decisions being made at the
state level and is there a role for the federal government in terms of incentivizing states
to adopt the best evidence as far as how those decisions are made? I also heard about Medicare and preparing. Medicare in terms of what's happening with
people in our country living with HIV and the importance of Medicare being in a better
position to provide support. And finally, I was struck by a lot of the
conversation regardi
ng criminalization and how we still live in the country where there
are sort of biased and unscientific laws that criminalize people living with HIV. Those are things that I heard yesterday that
I think are, in my mind, right for us to address as a advisory committee. And so, I hope that we will do that. Special thanks to all the PACHA members. I feel like the passion and the specific recommendations,
the clarity and the commitment was palpable. So, with that, I am happy to turn it over
to Carol
ine, who's going to be helping us with the roll call today. >> Caroline Talev: Thank you. Good morning, everyone. Kaye Hayes, Doctor Tim Harrison, Kristen Rohan
and a few others are with Admiral Levine for the National Syphilis and the Congenital Syphilis
Endemic Task Force meeting. So, they should be here shortly. But to kick it with at the roll call, I'll
say your name and if you can also say your organization location. So, starting with PACHA. PACHA Co-chair, Marlene McNeese. Present. Houston
, TX, Houston Health Department. >> Caroline Talev: PACHA Co-chair, Vincent
Guilamo-Ramos. >> Vincent Guilamo-Ramos: Present. Washington, DC Institute for Policy Solutions,
Johns Hopkins University. >> Caroline Talev: Guillermo Chacon. >> Guillermo Chacon: Guillermo Chacon. New York, Houston, Florida, North Carolina. PACHA member. >> Caroline Talev: Philip Chan. Philip Chan? Tori Cooper. >> Tori Cooper: Present. Human Rights Campaign, Director of Community
Engagement, Washington DC and all acros
s the country. >> Caroline Talev: Raniyah Copeland. >> Raniyah Copeland: Raniyah Copeland, CEO
of Equity and Impact Solutions. Los Angeles and worldwide. >> Caroline Talev: Mackenzie Copley. >> Mackenzie Copley: Mackenzie Copley, co-founder
and CEO of 110 health in Washington, DC. >> Caroline Talev: Alicia Digs. >> Alicia Digs: Good morning, Alicia Digs,
UNC Chapel Hill, Community Engagement Manager of the C4. >> Caroline Talev: Jennifer Kates. Jen Kates? Paul Kawata. >> Paul Kawata: Paul Kawata
and NMac Washington,
DC. >> Caroline Talev: Duvia Lozano. >> Duvia Lozano: Duvia Lozano, Phoenix, AZ
Chicanos por la Cosa Latinos unidos Contracida. >> Caroline Talev: Tiommi Luckett. >> Tiommi Luckett: Tiommi Luckett, Little
Rock AR transgender Law Center. >> Caroline Talev: Jesse Milan. >> Jesse Milan: Jesse, present. Jesse Milan AIDS United, headquartered in
Washington with staff in 17 states. >> Caroline Talev: Deondre Moore. >> Deondre Moore: Deondre Moore, President,
native of Beaumont, T
X, and board member to AIDS vaccine advocacy coalition and Provision
Access campaign. >> Caroline Talev: Leo Moore. >> Leo Moore: Present. Leo Moore, LA County Department of Public
Health, Los Angeles, CA. >> Caroline Talev: Laura Platero. >> Laura Platero: Present online. Northwest Portland area and Health Board,
Portland OR. >> Caroline Talev: Kayla Quimbly. Kayla Quimbly? Natalie Sanchez. >> Natalie Sanchez: Natalie Sanchez, Los Angeles,
CA director of UCLA, Los Angeles Family AIDS network. >
> Caroline Talev: Patrick Sullivan. >> Patrick Sullivan: Present. I am at the Rawlins School of Public Health,
Emory University in Atlanta, GA. >> Caroline Talev: Jeff Taylor. >> Jeff Taylor: Present. HIV and aging research project, Palm Springs,
CA. >> Caroline Talev: Marvell Terry II. >> Marvell Terry II: Present. Cultural organizer and activist, Atlanta,
GA. >> Caroline Talev: Hansel Tookes. >> Hansel Tookes III: Present. Associate professor of Medicine, University
of Miami Miller School of M
edicine. >> Caroline Talev: Carol Treston. >> Carol Treston: Present. Association of nurses and AIDS care. We're a global membership organization and
I'm in Philadelphia. >> Caroline Talev: Dafina Ward. Dafina Ward? Darrell Wheeler. >> Darrell Wheeler: Present New Paltz, NY
State University of New York, New Paltz. CDC/HERSA Advisory Committee on HIV, Viral
Hepatitis and STD Prevention and Treatment, or CHAC liaison Wendy Armstrong. Wendy Armstrong? Thank you. And now for our federal partners. Ti
m Harrison. Tim Harrison? John Oguntomilade. >> John Oguntomilade: Present. PHE coordination lead office of the Assistant
Secretary for Health. >> Caroline Talev: Jonathan Jono Mermin. Jono Mermin? Robin Neblett-Fanfair. >> Robin Neblett-Fanfair: Morning, present. Division of HIV prevention, CDC. >> Caroline Talev: Ernia Hughes. >> Ernia Hughes: Good morning. Present. Health Resources and Services Administration,
Bureau of Primary Health Care, Rockville, MD. >> Caroline Talev: Laura Cheever. Lau
ra Cheever. Andrea Jackson. >> Andrea Jackson: Present at the Health Resources
and Services Administration, HIV AIDS Bureau, Rockville, MD. >> Caroline Talev: Mehran Massoudi. Mehran Massoudi? Kristen Roha. Kristen Roha? Mary Glenshaw. >> Mary Glenshaw: Good morning, everyone. Mary Glenshaw, NIH, Bethesda, MD. >> Caroline Talev: Jessica Lee. Jessica Lee? Michelle Schriber. Michelle Schriber? Rita Harcrow. Rita Harcrow? Casey Knopp. Casey Knopp? >> Casey Knopp: Present. Casey Knopp. Administratio
n for Community Living. >> Caroline Talev: William Dilday. William Dilday? Rodrigo Chavez. Sharonda Brown. And Caroline Talev here. Oh, sorry. Senior management analyst in ODP and Alternate
Designated Federal Officer for PACHA. Thank you. >> Vincent Guilamo-Ramos: Thank you so much,
Carolyn. So, we've got a really packed second day of
our formal PACHA meeting this morning up until lunch, we'll have an opportunity to hear from
local folks around issues that are specific to rural and urban areas a
nd some of the challenges. We also will have PACHA the People after lunch,
which I think will be an important time to hear directly from community. I understand that there are some groups that
are here and that are also on their way that will provide some important perspective and
we're hoping to have time this afternoon for discussion, and we will adjourn around 3:45. So without any further delay, I am super excited
to be co facilitating with Marvell Terry II. So, Marvell I am not going to spen
d a lot
of time introducing you. I know you've prepared some wonderful comments
and so I'm going to turn it over to you. Thank you. >> Marvell Terry II: Thank you, Vincent. To my PACHA colleagues, federal officials
and to the community. Good morning. Good morning. I feel like Marsha Fudge. Good morning. Lucille Clifton and her poem “Won't You
Celebrate Me?” says quote, “Come celebrate with me that every day something has tried
to kill me has failed.” I think it is appropriate before we move forw
ard
that we pause and celebrate the resilience of Texas, of the South, of community, and
so can you just pause and in whatever way that you celebrate to celebrate the activists
and the resilience of people living in Texas. By 1995, the cultural and artistic hub that
is the South was tired of being put down. During that year's source awards, Andre Benjamin,
also known as Andre 3000 of OutKast gave Southern hip hop is battle cry, quote, “the South
got something to say?” End Quote. I believe that o
ur conversation today about
rural and urban perspectives will illuminate what poet and lyricist Andre 3000 was saying. That not only does the South have something
to say, but also Texas has something to say. My name is Marville Terry II and I'm a member
of the stigma and Disparities subcommittee and chair of the HIV Criminalization and Discrimination
Work group. I'm a person living with HIV and a proud Southerner. Yesterday we learned that in the face of racism,
challenges and infrastructure, an
tiquated laws, stigmatizing checkpoints, and just outright
stupidity, the Texas HIV Community, rural and urban, has been creative and innovative
in its approach to addressing HIV and the many social and structural determinants of
health that often push people to the margins. Communities that we heard from for the last
couple of days, the Latinx community, cisgender Black Women and Latinx women and brown folks. The first half of this panel is about rural
communities. You will hear from individual
s who have made
their work possible despite the many barriers that systems and policies have created in
the South and in Texas. I will ask the panelists to introduce themselves
and please describe the work that your agency does in rural areas. We can start here. >> Samual Hebbe Goings: Good morning. Good morning, everyone. My name is Samual Hebbe Goings. I use he/him pronouns. I am the HIV, STD, and viral hepatitis prevention
director at the Texas Department of State Health Services. I have been
working in this field for almost
14 years and I am just deeply passionate about the work
that we all do. The work in public health, trying to improve
healthcare services, reduce health disparities, and improve the lives of those that are affected
by HIV. Prior to my tenure at the Health Department,
I was one of the Co-founders of the Austin Prep Access project, today known as The Kind
Clinic. This is the first volunteer led standalone
prep clinic in the United States and I -- prior to that, I s
tarted off in public health actually,
as an intern at the Virginia Department of Health, working at the AIDS Drug Assistance
Program during a time where there was an ADAP shortfall and as a young person who was still
not out completely, I was really taken back by just the challenges that our public health
systems have in terms of funding, in terms of client services and supporting those living
with HIV too. And so that really kind of motivated me to
pursue continuing down this trajectory that I
was on. I joined the CDC as a fellow and made my way
to Texas. I was assigned to the San Antonio Health Department,
where I worked as a disease intervention specialist. And I -- throughout my career, I have really
just been really inspired by the people that I've worked alongside with and their deep
compassion and commitment to this field, and so I'm very excited and honored to be here
and I look forward to this conversation. >> Anayensi Almaraz: Buenos Dias. I am Anayensi Almaraz. I am the prev
ention program manager for can
Community Health in Arlington, TX. Our clinic in Arlington, TX, though it's based
there, does operate in several counties, including Wise, Somerville, E Rathhood, Johnson, and
of course, Tarrant County. We do this because we understand that those
areas are largely underserved, especially when it comes to accessing HIV treatment and
prevention services. Our clinic does have the ability right now
to offer a varying amount of services. We do provide HIV treatment and
prevention
and we also provide NPEP services. We have an on-site dental clinic that's open
to the community. We also have an onsite pharmacy that's open
to the community, we have case management for people living with HIV. We have patient access specialists that help
anyone, regardless of their status. And then we also have peers and of course,
our early intervention services team. So as a whole team, we really do try to approach
care in a status neutral way, making sure that we use what resourc
es we do have available
regardless of the individual status and of course, we have Ryan White funding that helps
in many aspects, but we also use our relationships in creative ways to try and fill the gaps. One of those being in our rural areas. And so, what we do in our rural areas to really
meet the need there is partner with organizations and/or companies that may be considered nontraditional. We focus on work with social service organizations,
food banks, free entry programs, substance use c
enters. Truly, anyone and everyone that will allow
us the space. In addition, we also do have a program that
is called Can Connect. Can Connect allows us to place a laptop in
these other clinics or in these other facilities, sometimes in health departments, so that we
do have the ability to offer telehealth services to those patients. We also work with labs nearby in order to
make sure that they all have access to labs close to home and they don't have to commute
into the cities that are closest
to them, because sometimes, we are talking about over
an hour commute. In addition, our mobile unit and our prevention
team, my wonderful prevention team, goes out into these areas every month and they make
sure that they are there, available for the Community. Our mobile unit is also equipped with telehealth
services. And so, if we do need to engage someone in
care rapidly, we are able to do so via our mobile unit and our prevention team, who is
trained in phlebotomy as well as initiating some
of that paperwork, whether it's necessary
for Ryan White or other assistance programs. So, we really, truly try to meet the need
and engage them right then and there and making sure that we do, of course, put the patient
first, which also brings me to our partner agencies in rural areas. Sometimes we are able to work with the partner
and get them connected to care in those areas instead of having them be a patient of ours. And again, we really assess what is going
to be the best case for the pa
tient and make a decision from there and our providers. We're also really big about doing provider
to provider education, so our providers are able and willing to speak with other providers
and give them the basic information needed to be able to treat HIV and/or offer prep
services. >> Dena Hughes: Good morning, everyone. My name is Dena Hughes, and I am the Chief
executive Officer for Triangle Area Network, otherwise known on the streets as TAN Healthcare
and we are located in Beaumont, TX and
I'm here today wearing multiple hats and my dad
used to always say just wear one hat, and what he meant was just be authentic in what
you're doing and where you are. And so, I decided with all the different hats,
I'd just sew a hat together with all the different pieces. I am a woman living with HIV. I have been living with HIV since the age
of 21, I am now officially 25. I am 54 years old, and I do remember a time
when I was told by my diagnosing physician that I had five to maybe 10 years to
live. So, every day is a joy. Every day has meaning. Every day has a purpose. I am also a mother. I have a beautiful 28-year-old daughter. She is actually here. I made her take off from work to show up. And she has been rolling with me diligently
her entire life, to the point where she is now a youth case manager for an HIV transitional
living facility. And so, I am also contributing to the workforce. So, thank you Candace for coming and being
a part of this today. I'm also an advocate. I've bee
n -- when I was diagnosed at 21, I
made it my personal mission as a college student majoring in communication that there was no
way I could live a life of silence around this and I don't have any judgment on how
anyone else chooses to engage, but for me it was give it away, right? And if people can deal with it, they can if
they can't, they can't. And so that led to the last, you know, 30
years working in the community as an advocate, as a young woman working in the jails and
working in the comm
unity. And as I got older, being able to actually
work within the institutions, being at the decision-making table, making choices about
dollars and I recognized and I've always known the importance of having the positive voice
at the table, no matter what decisions need to be made. So, I am very honored to be here with you
all. Today, TAN Healthcare and I have a group of
people walk in in a minute. It's my team. I had them also come from Beaumont to come
in. Oh y'all are right on time. So, this
is -- you have to share the light. So, this is a representation of the team that
works in Beaumont with me. The first person. I just want to highlight, though she's wearing
her delta gear is my director of medical services her name is Dr. Maisha Clifton. And the crew, right. But I wanted to just particularly point her
out because I think it's important to recognize the providers who are in these communities
and who are doing this work. TK, raise your hand. That's outreach. He goes out, he does
-- he does the work in
the street. And so, we're just -- I'm glad that they were
able to take away some of their time to come and be a part of this because I want them
to see that though we are rural, we are not basic on any level, we are not, basic. TAN Healthcare is an FQHC, we're a federally
qualified Health Center, but we have the unique distinction of having been a AIDS service
organization for 37 years. We were the first ASO in Southeast Texas,
and we remained that way for many years until
we were joined by legacy community health
and the amazing work of smart health clinic with my fabulous colleague, Cordella. We do all the work, we are -- we have all
-- we have the services we have the telehealth, we have the rural health, we have multiple
locations, but I didn't know rural. I'm a transplant. I'm a Houstonian, by raising. And so, when I made the transition to the
rural community, it really felt like I went from going 100 miles an hour with Miss Marlene
McNeese to almost a sudde
n stop. Because that -- the information, the infrastructure,
that it wasn't there in the rural community and if it hadn't have been for Cordella asking
me out for time one night, we had to do it on our own. And so, one of the issues that that I hope
to address with you all is the issue of infrastructure in rural settings but I am very honored to
be here very happy to be a part of this ongoing conversation and I look forward to hearing
from my fellow colleagues as well. Thank you. >> Cordella Lyo
n: Good morning. I am Cordella Lyon. I'm the HIV program coordinator at Baptist
Hospitals of Southeast Texas and by trade, I am a registered nurse. I am a member of Anac, I am also the Community
co-chair for the Texas HIV Indicate and the President of the Boston Congress of Public
Health. That's all for now. I know we all want to get out of here early. I am – and don't be bothered by my accent. I know, I am Jamaican with a touch of Texan
so you you'll be alright. You're in good company. Baptist
Hospitals of Southeast Texas is the
only Regional Hospital that provides routine HIV testing and linkage to care in their emergency
department. I am grateful for the transformative leadership
of our hospital that embraced this program 13 years ago when Jefferson County was ranked
4th in case rates with people who are living with HIV. I'm also grateful to the Texas Department
of State Health Services that walked into Beaumont and believed that a rural hospital
could make a difference in HIV testi
ng and linkage to care so that by 2018, Jefferson
County was ranked 12th in the state with people living with HIV. Baptist has been the leader in healthcare
in the community. Our service area is 8 counties. It's just about the size of Delaware. We are rural, regardless of what our population
size is. We are rural, we do not have the infrastructure
that urban communities have. There is no transportation that links people
between cities. And for that reason, we have to be innovative. We have been,
we've managed to turn that challenge
into change in that we identify our partners who have common interests. We have succeeded in building private Public
Partnerships that are addressing HIV and hep C. Here we have syphilis in that kind of a
syndemic approach to healthcare. In doing so, I must say that it has allowed
our community to also look at stigma in a different way when it comes to HIV testing
and linkage to care because routine testing prevents the stigma of testing. And since we levera
ged our routine testing
to incorporate Ryan White Care, then routine care, destigmatizes HIV care as well. I know there's going to be more that we will
discuss about hospitals and how we function in rural communities, so I'll leave that for
now until we get into the nitty gritty of our questions. Thank you. >> Marvell Terry II: Thank you. Thank you so much. We're going to have an exciting conversation
around rural and in our framing of this conversation, we attempted to define rural, and we reco
gnize
that every agency, every federal agent, every department of government defined rule as something
different. And so, we wanted to allow our panelists to
kind of contextualize that for us. Could you help us to better contextualize
what are the core issues for individuals, vulnerable or living with HIV in rural areas? >> Cordella Lyon: One of the issues that I
know communities face is a lack of expertise for HIV care. When we look at that challenge, we also understand
that maybe the solution
as they bring that challenge to you is providing our graduates,
our medical graduates with relief for student loans to practice in rural communities, I
mean it is unrealistic to believe that a new graduate is going to pick up their bags and
move to rural communities to practice when they do not have an airport -- an International
Airport. There is no space for entertainment. There is -- there probably -- there's probably
question questioning the education system for their children. So, we have t
o make-- get so much more enticing
that they will come to rural communities. >> Anayensi Almaraz: To add to that, we also
see stigma, and of course, that exists everywhere, right? Unfortunately. But in some of our rural communities, they
are so small that if one person finds out, the whole town finds out. And even with something as simple as getting
tested for HIV, and so our organization does take the opportunity to advertise health screenings
instead of rapid HIV tests, and in efforts to norma
lize it, we also can pair it with
the blood pressure and a glucose check with the equipment that we purchased, you know,
from a Walgreens, a local pharmacy, but in efforts to normalize not only getting tested
for HIV, but also not being known as why are you getting on that bus that does HIV testing? Because again, we're talking about really
small communities, a lot of them still have really strong ties to religion, faith, etcetera. And so, keeping all of that in mind, how do
we come into a commu
nity that is so small in a neutral way? >> Samual Hebbe Goings: I just wanted to add
to that conversation. I think those are the two biggest issues,
infrastructure, and stigma. So, I grew up in a small town, so I'm living
in Austin now and that comes with a lot of privilege, living in a big city inside of
a bubble. But I grew up in a small town in southwest
Virginia with a population of 4000 people. And so, if I was a young person trying to
seek out testing services, I didn't know where to go. M
y dad was the town doctor, so -- and so everyone
knew him, my family. And so that that's sort of thing where that
connection where everyone knows each other, everyone is in your business that is that
can be difficult and that can help perpetuate the stigma and fear to going out and seeking
service. I think in terms of infrastructure in rural
health -- so I'm a numbers person. So, Texas is a big state, we have 254 counties,
171 of those counties have a population of under 50,000 people. And so, w
hen you look at that, we have -- while
we concentrate our efforts where the epidemic is -- where the greatest needs are, it also
-- it creates a lack of visibility for all of the rural communities. And I think when we -- when we talk about
service gaps what we're talking about is these counties where someone has to, you know, they
they're one medical doctor or they're one, maybe HIV testing organization or maybe not
even that. Like we're talking about just a healthcare
provider. If they have a f
riend or relative or someone
that they know that works there, they may not be that -- they may not want to go there
and seek services. And so, I think that is definitely some of
our biggest challenges is looking at infrastructure and the stigma and options for services for
people. >> Dena Hughes: I think one of the things
I separated when I looked at that question was, you know, the core issues for the possibles,
right. I think I heard that word used yesterday as
opposed to negative. But the pos
sibles as well as the, you know,
people living with HIV because we were an aid service organization. And the community already was aware that if
itches, scratches, burns or whatever, come to TAN, that was a well-known fact as we transitioned
into the FQHC space, we now have the ability to serve, but yet everyone still knows if
you if this is what you need, come here. So, for the positive community, when you -- when
you come in and you're getting screen. You have providers who know how to navigat
e. I didn't say it, but my amazing provider is
a dual certified HIV specialist in the rural communities. So not just the provider she specializes in. So care is one part of that that dance. And I believe we dance that very well when
it's getting them into -- get screened and get into care. But for the possibles, that's a whole other
at risk conversation. We started talking recently about where are
the 18 to 30 year old African American women in Beaumont? Guess where they are? Houston, on the wee
kends, Friday, Saturday,
Sunday, well, now they go to the park on Calder a little. Bit but, but they're here and they're in New
Orleans, or they're in Lake Charles. They're leaving the community and they're
going out and they're having a wonderful time in a much bigger city with a greater level
of exposure and then they come home to us, and once they there is a need for that screening
or that care now we're saddled with the burden right of being able to provide that care. And so I think what we
need that core issue
for people who are not living with HIV is we want to prevent so prevention is a is a
big part of this conversation and I'll be honest one of the most difficult things for
me to wrap my head around, especially after having lived with all of you for so long and
we talked about black and brown and women go to Kirbyville, Buena, Jasper, Newton, right,
2%, 4%, 6% black and brown. But yet the poverty rate, high unemployment,
high drug use, high. So, I think we've got to figure out
how to
be a bit more incorporating because it is strange to go somewhere. And go what about white poor people? That sound crazy, right? Saying that, but that's still a reality. And so getting those prevention messages into
rural communities where you have issues. Around faith and you have issues around politics,
and you have all you know, you have all these barriers. They're different than what you would experience,
I think, in the urban settings. >> Marvell Terry II: Thank you for that. I want
to continue to interrogate this idea
of rural perspectives and what does that look like? And so this question I didn't send to you
all in advance, but we're gonna flow with it okay? Okay. Paying for us, what does infrastructure look
like? What are the infrastructure challenges that
you all are experiencing in rural areas? Sure. >> Dena Hughes: Cordella and I have been living
infrastructure for several years now. That is by far the -- one of our biggest challenges. And when I say infrastructure,
I'm talking
not just about organizations partnering together to use the resources we have, wisely. We’re talking about decision making. I am now in the mindset that Houston should
not be making a single decision about what happens in Southeast Texas. Not a single decision. And we have to --we have to use our data,
we have to send that information in, but we don't necessarily hear the full conversation
nor are we able to really get that access that we need to a structure that will allow
us to us
e the resources, whether it's the health department, the Jefferson County Health
Department, we have to be able to connect all of these pieces together. Cordella and I can't keep driving to Houston
to talk about what's going on in rural America. I can't take my staff out of what they're
doing and bring them somewhere else. We need to be able to have those resources
and those conversations about our dollars and the services that we need, they need to
be done more locally. One of our challenges al
so is that when you're
looking at counties, counties have a different political structure than a city has. The – it -- they're like mini fiefdoms,
right? And so, you have to make connections with
each of these county entities. You have to figure out how to benefit them,
how you -- how they'll benefit you. So, if I'm doing it, Cordella’s doing it,
someone else is doing it. We have no coordination. And so, somebody either walks away with all
the pie and none of the pie. So, part of that is, how do
we, and whether
it's capacity building or technical assistance, how do we do that? I will say that the state has definitely stepped
up in the last year or so and pulling us together, but I'm not necessarily funded to do this
work. I come to the table as a volunteer. So you're expecting people to come to the
table and do this work, but there are no dollars to support the work you're asking them to
do so. >> Marvell Terry II: Anyone else would like
to comment on infrastructure? >> Cordella Lyon:
And I agree with Dena, that
would have been a part of my response, very nicely said and I'll go into the structural
issues that rural communities have, especially in the South, understanding our risk for disasters. And the impact that it plays on our community,
on personal lives when someone has gone through Harvey, lost their home, tried to rebuild
and Imelda knocks it over, and then try again and another storm comes in. It's not just that mental displacement, that
not having the access and res
ources for mental health care, the cost of housing has now gone
up because housing is scarce, housing is a primary need for healthcare. And in rural communities, when we have to
push people further away from their resources, from their doctors, from their grocery stores,
from the hub of their activities, then we're pushing them up pretty much into nonexistence. And so that is a big issue, and I do understand
that as we sit at the site, we're trying to find solutions, but more has to be done inte
ntionally
and how we look at housing as preventative measures in healthcare because none of our
patients are one-dimensional in just living with HIV. >> Marvell Terry II: Thank you for that. To position this question for you, you mentioned
hospital systems earlier. How do we best utilize hospital systems in
rural areas? >> Cordella Lyon: I'm going to say this with
a backdrop that as we all know, sitting at this table, many rural hospitals are closing. If they're not shutting the door completely,
they're closing essential services. Just last night I heard that one of our rural
hospitals will be closing their mother infant unit in Nacogdoches. OK, but how do we utilize the system you ask? Hospitals are the central ground for anybody,
regardless of age, race, ability to pay, gender or sexual identity. What we found at Baptist is by doing routine
screening in our emergency department, we've been able to identify people who never thought
that they would even have been exposed to HIV. We use
the CDC guidelines, screening those
who are 18 and older. Our oldest patient was 72 years old, who presented
with doubt. Had no idea she was living with HIV. So, hospitals also have the neutrality that
can engage other entities in the community. Because I know for a long time in the HIV
sphere, funding caused people to be territorial. This is my patient. That's your patient. This is where I screen. That's where you screen. So on and so forth. But when hospitals get in it's because that's
a neut
ral ground. They can pull other people to the table to
have the productive conversations that are needed to care for the community. There is also that respect that the hospitals
have, and we did, in our TAN legacy, all the players we have worked together around that,
we call them our stakeholders. Okay. And this works also with bringing in pharmacy. For many of us, I'm not a pharmacist, but
my patient needs the assistance of a pharmacist. The hospital is able to leverage that, we
bring in the he
alth departments as well. And when I talked about using a syndemic approach
to addressing HIV where else does it happen than the hospital? That's where people with mental health issues
are. That's where your diabetic, who's now finding
out that they are living with HIV or hep C, that's where they are. So, we do have the opportunity to lead on
this. I do understand that it is strenuous because
who will pay? That's always the big question. But, when I look back and remember our response
to COVID,
operation warp speed required private public partnerships. The federal government needed pharmaceutical
companies who already had vaccines ready or could make those vaccines. Hospitals can leverage private Public Partnerships
to address HIV or any syndemic that's out there and -- the discussion yesterday was
about funding and the requirement for you know, that applicant to have a certain amount
of money. Well, hospitals have that background. They can get into the game, they can make
the differen
ce and they can bring in other partners as sub grantees to address the issues. >> Marvell Terry II: Can I ask you a follow
up question? In rural areas, what is the relationship between
hospitals and community-based organizations who are fighting HIV? >> Cordella Lyon: I can speak specifically
to Beaumont, and I'd say we have a wonderful, respectful relationship. We respect the autonomy of all where CBOs
and ASOs and what they can encounter to, and they respect us as well. We stay focused on the
client, the patient,
the consumer, or the issue. I know that -- and I'll share this with you. We work closely with our health departments. We need them and they need us, and it was
probably nine years into our program that the director of the health department came
to me and she said, Cordella, I need your help. We are giving our first responders 30 days
off with pay when they have an exposure to a bloodborne pathogen, we have to revamp our
policy. And they brought in the experts. The medical sc
ientists, the community layers,
and teaching them about HIV exposure, I brought in the pharmacist as well. And now the city is saving money on, you know,
their salaries because they're not giving people 30 days off with pay while they pay
overtime to fill those slots because they didn't understand that when somebody was exposed
to HIV, they're taking the same medication as people who are living with HIV take every
day and go to work, but because the hospital had the trust of the community, we we
re able
to help them to do better and to be on the cost savings end of an HIV exposure. Hospitals can also provide PEP in the emergency
department. It doesn't take funding to prescribe PEP. It takes the will to prescribe PEP, we prescribe
PEP and PEP in our emergency department, and Leila and Brandy are here. Our fairness now of social workers at smart
health patients are linked to care after they receive their first dose of PEP in the ER. They're given their prescription, and they
follow up wit
h smart help. Hospitals can also help with reengaging people
in care, in our inpatient settings when a patient is admitted and you're going through
that assessment, do you have diabetes, hypertension, so on HIV and HEP C are there. And it's not just do you have HIV or hep C
is, are you in care? If they're not in care, I get a fax right
away. So, while that patient is in that bed, I'm
at the bedside. Hello, Mr. Brown. How are you? And I'm reengaging that patient in care. That does not take fundin
g. That takes the will. And our EMRs, we're already paying for it. So why not tweak it to suit our needs? So those are some of the little things that
I know. Rural hospitals, you know, it may be difficult
to think about, oh, I have to apply for a grant, but those little things can be done. >> Samual Hebbe Goings: I just wanted to add
to that conversation. Cordella thank you for everything. I also just wanted to let folks know that
hospitals are often a teaching environment for physicians, and I
think that is something
we can also leverage. You know that you talked about hospitals being
in this institution in the community. And I don't want to generalize because hospitals
are struggling too, especially in rural communities, but hospitals also have expansive networks
where they can recruit providers to come and maybe spend a day at the rural hospital location
or another branch of that, and so it's encouraging hospitals to do that. I think is something that will help us down
the road and
encouraging education., so through grand rounds through provider education and
just getting to shadow the amazing work that Cordella is doing in in her in the routine
screening program sets the groundwork for that work and the sustainability of routine
screening to happen. So I think that's just another important. >> Cordella Lyon: Thank you so much for mentioning
that because I forgot hospitals can -- rural hospitals can participate in clinical studies. I know there are so many studies out ther
e,
but does it reflect the needs of rural communities? We talk about social determinants of health,
but what does it look like for people in rural communities? We talk about quality of life issues, clinical
studies can bring forward those voices if they're done, you know, in hospitals through
we do have an internal medicine program as well at this hospital. So those issues can be brought forward and
can be done with private public partnerships because I know all the pharmaceutical companies
are
interested in learning why patients may not be staying on their medications and what
does it take to get somebody virally suppressed? >> Marvell Terry II: Thank you for that. Dena, I want to ask you about technology. We know last year the Biden administration
authored a bill to support infrastructure and particularly around technology in rural
areas. How has technology impacted the work of your
organization? >> Dena Hughes: I would -- I think of technology
in in two ways. One, the technology tha
t's available to providers
and our staff with, of course, COVID, we had to turn on Telehealth and I -- maybe two years
before we had talked about Telehealth and everyone was kind of saying it's going to
take a minute, when COVID came, it took two weeks to turn it on and get it going, but
also being able to access medical records, other medical information from our hospital
partners or other providers, that level of technology has really increased, but it's
it was an investment that we had to mak
e as an organization to put money toward building
that infrastructure and being able to tie in to the HCCN or clinically integrated networks,
and really be able to benefit from that technological resource. On the patient end, we thought man, telehealth
is going to be great for our rural patients. They want to come in and they want to see
their provider, they want to see we have a mobile medical clinic, and we take a mobile
unit out into the community, we can telehealth for individuals from the m
obile unit. They are going to drive to the unit because
they want to be face to face. It's a very different relational conversation. So it's not just is there broadband or do
they have a signal, those are definitely key issues. Do they have Internet at their home? Where do they have to go to get access to
Internet? So that's still a challenge, but at the core,
and I think everyone would agree, patients want to -- rural patients, they want to have
that relationship. We had one provider and we kep
t looking at
her data and we're like, Oh my God, she's taking so long to see patients in the rural
area. Well, that patient would bring in their mom
or their brother, can you look at -- and also -- or are they coming in with health conditions
that have exacerbated to the point where those visits are take up way more time than you
would expect to see in maybe a more urban setting? So, though technology has been a benefit for
providers for organizations to be able to share data in real time and tu
rn on some of
these additional access points, part of the conversation is helping our community recognize
that there is value in utilizing telehealth. Now the one thing that's a little different
than telehealth. Is the portal, like our Hilo apps and our
apps to get our data, that works well. They love it, they -- that is a -- well you
-- so we're looking at what are how is it benefiting, where are we seeing benefit, where
can we maximize and then where do we need to grow in additional spaces. Bu
t across the across the area, technology
has definitely been a benefit. It's just a matter of how do we turn it on
and turn it up in some areas. >> Marvell Terry II: Thank you. Thank you for that, Anayensi, thank you. We talked about some of the existential things
that rural organizations might face, such as weather. How did your organization work through harsh
weather? And most recently, COVID how did your organization
manage through that in the rural area? >> Anayensi Almaraz: Yeah. So, as it
was mentioned, a lot of our rural
patients do want to see a provider in person, but during that time I think, COVID specifically
brought fear to a lot of communities, and so during that time we were able to utilize
telehealth services. We were able to utilize our Can Connect program,
and we were really able to try to continue efforts in those ways. Of course, we also would supplement as much
testing as possible through the use of home test kits, but our organization actually opened
its doors in
Arlington, TX in October of 2020, so that was in the midst of the pandemic. We never, ever shut down, not our prevention,
not our testing, not our clinic because we acknowledged that there was still a need,
right. And so, with all of the safety precautions
that we could possibly take with screenings at the doors, the temperature checks, making
sure that our staff and our patients were in PPE, necessary with offering the rapid
COVID tests, all of those things in combination was how we were able t
o continue to provide
services during that time. I personally remember being in 100° weather,
full PPE, face mask, your -- everything and it was sweaty, but it was worth it because
we knew that a lot of other agencies were just not able to keep their doors open during
that time, and whether I'm actually native to Arizona, I moved here -- so I'm a transplant
into the Dallas Fort Worth area, I never once had to worry about tornadoes. But when that first alarm went off, I had
no idea what to do. I
am so grateful for our practice administrator. I called her and she said sit in your closet. So, at 9:00 in the morning, I took my first
meeting in my closet, waited for the sirens to come down and then kind of game plan for
the rest of the day. But it truly does take our team, myself, my
director, our risk management side to keep an eye on the weather, to keep an eye on kind
of those alerts that are coming out and what areas they're expected to impact, and we wait
until the last minute to make
a call, but ultimately if it's not going to be safe for
our staff to drive out, if it's not going to be safe for community members to be there,
then we are going to look at rescheduling. We always, always, want to reschedule, not
cancel, but again, keeping safety in mind for everyone in both COVID and weather conditions,
it's our number one priority. >> Marvell Terry II: And I want to ask that
question also to you, Dena. Having a community-based organization. The -- yes, the preparedness can hap
pen, but
what does it do to the morale of staff, the morale of community? What does it do to one's well-being that at
any given moment where I receive my care or even community can be uprooted? >> Dena Hughes: You know, one of the things
that I completely agree with you, we also -- we didn't close during COVID. We had to find a way to stay open and stay
available to the community. But Harvey and Imelda and even with the ice
issue. You know when those things happen, one of
the benefits of being i
n a smaller community is the rallying effect that it has on everyone,
right? We will come together, we will open our facility
for disaster related activities. You know, whether it's having water brought
in that you can share with the community where now it doesn't matter if you're a patient
of the Health Center, you're in the Community and you have a particular need. And so that is one of the benefits of being
more closely relational in that way, but we, you know, the struggle is really how do y
ou
make that balance happen for your team, right? And for the people that are doing the work. We have at TAN -- probably 85 to 90% of our
staff are women. A good significant portion of that staff are
moms and have families, and so having that flexibility and allowing people to live their
life, but let's still get the work done. You have no choice, because there's not enough
of us doing the work to be available. When these guys get called evenings, we have,
of course, you know nontraditional hour
s of care. We have the on call, we have. You know we have access to the staff and so
trying to make sure that we pour into who's doing the work is extremely critical. But it's also very hard because you would
-- you want to maybe compensate, right financial compensation. You may want to do some of these things, but
that also is difficult if you have limited resources. But maintaining that balance for the community
when they're in need is critical. And so, I'm very grateful that I think we
tend t
o rise to the occasion, especially in those disaster areas, and we're able to partner
with our other local government or community organizations to make sure that all of the
resources are there at the table, but that balance is definitely a challenge. >> Marvell Terry II: Thank you for that. As we continue to look at HIV in rural areas,
what recommendations would you provide this body to make your work easier? I won't use the word easy, but how can we
make? What recommendations would you give th
is body
to make your work in rural areas easier? This is a question for everyone. >> Anayensi Almaraz: I would say I know we
talked about funding before and we're going to keep talking about funding and maybe sound
like a broken record here, but I think sometimes our limitations are because of the funding
limitations. They don't allow us to utilize funds in different
jurisdictions and or areas, and so of course again, we get creative on how we're able to
provide services in these areas, but it's
interesting how something that is awarded
to Tarrant County, we know that people commute from Dallas, from Johnson, from you know,
all of these surrounding counties for work, play, etc. Yet, we are not able to provide services in
those areas because of just what a paper says. So really pushing to be able to have the flexibility
there I think is important. >> Samual Hebbe Goings: So, thank you for
sharing that. And I think that that's definitely something
that's important. When I came in as the
prevention director
at DSHS, that was one of the things that we changed in our RFP's was because we recognize
that the impact of organizations can have not only in their local community, but also
statewide. We have several examples of organizations
that have done that successfully to provide telehealth, for example, doesn't have boundaries
or borders. I mean, yes, in terms of state law but yes,
to be able to have the options to do that, to have the flexibility in funding. I think another recomme
ndation that I would
add is there are -- to my knowledge, there are no interventions or specific prevention
strategies that were developed or intended for rural communities, for people who are
-- rural communities, people who inject drugs, nonwhite MSM populations in rural communities. And so I think that is something that we also
looked at changing so. Rather than only stick with the evidence-based
interventions, the Abbies or the interventions that were designed in urban areas that then
were e
ither adapted or modified to another population, it's hard to really look at that
and understand. Is that really something that you can generalize
to any setting? So we wanted to open that up and have communities
identify what their own needs were and to lead with their own interventions and options
and to be innovative and to give them that flexibility to do that. So, I think that is something we also need
to look at. >> Cordella Lyon: One of the things that I
think would help rural communities
in understanding the logistics of how difficult it is for people
to get to care is, in that same RFP, providing the opportunity to fund spaces like Unite
Us, which is a platform that connects clinical and social work. It -- it's HIPAA and FERPA secure and I do
not work for Unite Us, but it is a useful tool that I can send a referral from the Ryan
White facility to the Housing Authority to get somebody into that housing program without
having my patient leave my office, try to find a bus take of
f from work to get to the
other side of the county for housing, and then a lot of times even with referrals. We don't know if the patient made that connection
until they're back in the ER three months later, telling us they couldn't go because
the supervisor threatened to fire them if they took another day off from work. But this is a useful tool that allows the
person who you refer the patient to tell you if that patient made the appointment, what
the steps were and what the outcome is. But tha
t allows, instead of saying oh funding,
funding, put it in the RFP and allow us all to be able to talk to each other and how we're
linking patients to care and making sure patients don't have to figure out how to take off -- it's
an entire day from work for somebody who's not salaried. It's an entire day from work for somebody
who gets paid daily. And those are the issues that our people in
the rural communities face. >> Dena Hughes: I think for me the definition
of what is rural is important. W
e have a brick and mortar site in Beaumont
and we have a brick and mortar site in Orange. And of course we have the mobile clinic that
travels the full six counties. But from our brick and mortar in Beaumont
to our furthest location is two hours. That we have to drive to get there and get
back. I can't apply for any rural state funding
at all because I don't have a brick and mortar in what the state considers a rural area. Right? And so, I have to look for other sources to
continue to provide th
e range of services that are actually needed in some of these
spaces. And so I think looking at what does that look
like and anyone who has space to have that conversation, what does will really look like? Jefferson County, Orange County and Hardin
County, which are southeast and all the way going to the Louisiana border. They're not considered rural. I don't know how that's possible, that that's
not a rural area and so the resources that are available to where the hub of people exist
aren't the
re. But then we can't have EHE either. So how do we make any of these things happen
if we're not fitting in any of the defined definitions? So that's definitely one space. And of course I go back to infrastructure,
and if we need to, we are happy to invite anyone -- everyone down to Southeast Texas
to really take a look at what -- how should our infrastructure be formatted? How should we look at, and who are the partners
that we want to include and incorporate? We're starting now from a cluster
detection
we had earlier last year. We're starting to look at engaging with private
providers who actually offer testing, and we looked at the list, and they offer testing. And so, we need to continue to make these
relationships. But when you had asked the question, how does
Cordella work with, or hospitals work with the CBO's, there's three of us. So that's four people we have lunch, right? There's not enough of us doing the work or
engaging. And so I think being able to make the resources
more
available and establishing more collaborations in that public private space is another way
that we can really maximize the resources that we currently have. >> Marvell Terry II: When I ask one more question
before I open it up to my colleagues to ask our panel -- panelists questions, you mentioned
EHE. What should PACHA understand in regard to
advancing EHE work in rural contexts? >> Cordella Lyon: EHE needs to -- is not visible
in rural communities. So there needs to be visibility, as Dena jus
t
said, we're not, EHE, and we're not rural, we're there. We're just there. But my question then is where do we go from
here, where halfway through EHE, is there then the opportunity to extend EHE to rural
communities, having those who are already funded say okay, now you have a template get
a rural partner. In this age of technology, we can share our
data in this age of technology, we can share our skill set. So is that the -- an opportunity then okay,
you won't, we won't be funded, but should
those who've already been working for five
years have something ready to be replicated and then they can build other communities
from what they've done over the last five years. >> Samual Hebbe Goings: I would add to that
I think laying the groundwork and getting ready now to extend the EHR initiatives into
rural areas. I know there are some states that are funded
statewide EHE activities because the predominant, or the states like South Carolina where the
majority of HIV prevalence is in rural
communities in that state, and so learning lessons from
those from those States and that that have significant HIV prevalence in rural areas
and translating that those innovative interventions into other rural communities, that is work
that we can start doing now, we don't, again the capacity building to support those are
things that can help rural communities more. Yes with funding but I think that that support,
the peer-to-peer networks, and workforce development are all things we can start to
do now. >> Dena Hughes: I think the innovation is
another area, being so close to Houston and being from Houston having access to resources
like, you know, the public, the health department or other CDOs. We work together because we recognize that
the I-10 corridor, it's 90 minutes to get from one end to the other, and so we want
to make sure that we have the same resources so that individuals don't -- particularly
those who still struggle with the stigma around a new diagnosis, don't feel like
they have
to go all the way to Houston for care. We want to be able to have all of the resources
available in our own community to be able to support them long term. So I would add, you know, that particular
piece to that conversation. >> Marvell Terry II: Thank you. I would now like to open up the floor to my
colleagues who have questions. If you could raise your tents. If there are any, I will start to my right
Marlene. >> Marlene McNeese: I just want to thank you
Marvell, for facilitating an
d really guiding us through this conversation this morning
and thanks to all of the panelists. Really appreciate your important insights
about what we should be considering about how to better support the work that is underway
in rural communities, I have a specific question around healthcare access and some of the strategies
you may have taken, and in context, I was thinking about a report that came out a couple
of years ago where it described the proliferation, if you will, of community health
clinics over
the past ten years in Texas, and they did some analysis county by county. But one of the things that was illuminating
to me from that report is despite this growing proliferation of community-based health clinics,
FQHC's, etcetera, there was a reduction in the number of patients who actually were able
to access those services in the same time frame. And so, I'm curious as to some of your -- and
you talked about some of the reasons why transportation obviously hours of access etcete
ra. But can you share some successes that you've
had in ensuring that you maintain the level of access that's appropriate, that makes sense
for the kinds of needs that you see in your communities. >> Dena Hughes: As a, and again, we're an
eight-year-old FQHC. So, we're still in baby steps. We're still working, working through, but
because we were an aid service organization, we were able to maintain some of the processes
that were already in place that we were successfully doing. We, in addition
to having rapid HIV screening
available for HIV and syphilis, there's a rapid avenue, we also do routine screening
in our visit, same as Cordella and Baptists. And so, we want to make sure we have dual
routes of access for individuals depending what they're coming into the Health Center
for. In our rapid screening situation, if a person
has a has a initial positive reaction, then, that individual is immediately placed on the
provider schedule. There is no wait, there is no who's next. They imme
diately go right across the walkway
and they're placed on her schedule. Staff are fully educated from front desk all
the way through the care management and how to navigate, how to access medication assistance,
insurance and so that routine and that rhythm. Because we've done it for so long, it's supernatural
to how we move and I think it's one of the reasons why again you may struggle with coming
to TAN, because you don't know that we do a lot of other things, but when it comes to
an HIV or STI
diagnosis, you know exactly where to go for that support, and so that's
one of the real benefits and it's a trust building relationship as well because when
you're in the situation and you know the stigma, the disclosure, the confidentiality, it is
exacerbated in rural communities. It is huge, I mean, and I have to give super
love to DeAndre because he came in and single handedly like popped the bubble with his amazing
campaign and we love and appreciate you for everything that you did to reall
y normalize
living with HIV in the community but having to navigate that space, being a part of a
team that knows exactly how to move a person gracefully because it's that first and initial
relationship that you have that's going to testify to the rest of how you navigate your
own care. And so that's definitely one of the things
I am super proud of this team because when that hits, when we have a new diagnosis and
they come in. They’re constantly coming in, the response
and that navigation is si
mply phenomenal. It really is. >> Marvell Terry II: Thank you, Alicia. >> Alicia Diggs: Thank you all for sharing
as you have about the rural areas and this question is for Cordella, you mentioned that
the rural hospitals can participate in clinical studies and understanding the historical trauma
that and has impacted black and brown bodies over the centuries. Contributing to mistrust in the medical system,
how do you all connect patients with clinical studies so that they know they are availabl
e
and are there advertisements in the clinics, social workers, or research assistants available
to speak with patients to tell them about these available studies and if so, are there
pushback from the patients? >> Cordella Lyon: Thank you. Yes, we do have a research team that is diverse. We -- our care team is culturally diverse
as well. And you -- our patient navigator who's listening
online, she is a member of the Hispanic community. And you know represent which represents what
Beaumont looks
like. We provide the information, and we follow
the guidelines of the study in how patients are brought into the clinical study. The one study we currently have is for patients
who are newly diagnosed with HIV. So, it starts there, there is no promotion
going on in the. Clinic. This is something that's pretty much done
as one-on-one as we meet patients who meet the criteria for the studies and we give them
the objective information and we stay available and accessible to answer questions. They k
now that this is a -- it's a volunteer,
you know? They don't -- they're not mandated to do it. It's all about having the frank discussions,
as I said, again with hospitals, it's building trust and the people first start trusting
who they can relate to until we prove otherwise. And that's where our team comes in, in making
sure have you ever had the opportunity where you try to when you know it's a scam, when
they tell you, you have to sign up today. Well, so that's not how it is with us. It is t
he information in a language they understand
being available and accessible to answer questions, having them know this is voluntary and everything
else along the way. Now it's not a clinical trial. These medications have already been approved
by FDA. It is a clinical study. We may be looking at the more social impact
of it, which is an easier promotion, if you will, because then they know it's already
FDA approved. They would have gotten it anyways. But you're in this study to see how, you know,
things are based on race or, you know, gender or something like that. So yeah, we begin with trust and having patients
understand they are in charge. >> Marvell Terry II: Thank you. I have a queue Ernia, Carol, Devia, and Guillermo
and DeAndre. After that we will need to move forward. >> Ernia Hughes: Thank you so much Marvell. You've asked the best questions. I barely have a question to ask and thank
you to the panel for personalizing what it means to be in service to rural communities. It rea
lly kind of helps us get smart in the
most intentional way. My question is for Dena. What I'm claiming Dena, we're two Hughes in
the house. I don't know that she claims me, but I am
claiming you. So as a FQHC, you know, you've been on the
journey with the Bureau of Primary Health Care with the federal government to submit
patient level data. And so, I wonder if you can share with me
what you want us to be most mindful of as we enter into that process. I mean that is a very specific road to trave
l
with that needs to be done with great care and attention. And so, you certainly have my attention. And so, what do you want me to think about
most as you think about the process of submitting patient level data to us. >> Dena Hughes: Absolutely. I think for us, it's being able to give a
comprehensive and full picture of our patient population though we have a diagnostic avenue,
we also have a lived experience avenue in terms of where are our patients now. We were talking yesterday about how ma
ny of
us are growing, we're getting older and we're looking at HIV and aging. But we're also looking at diabetes. We're looking at hypertension. We're looking at this larger story that we
have to tell about the needs and the care of our patients and then the ultimate cost
of our patients. So being able to I mean, we're learning to
how to use the data better as well in talking about technology, we're now implementing Azara
health where we can get more real time data. We can get more real-time acc
ess to what's
going on with our patients. We're focusing more on value-based care and
taking that approach to making sure that we're incorporating prevention and we're incorporating
screenings at particular levels for people to really be knowledgeable so that we can
prevent, or at least get a heads up on critical issues that you know in an individual may
be living with so for us, we're trying to learn more. We're trying to learn more how to tell the
right story because oftentimes sitting in a ru
ral seat, I can't say I serve thousands. I don't -- I have -- but when I have, it's
often deeper and the issues are more substantive in terms of SDOH and other concerns. It's a thicker, denser situation that we often
find ourselves in because we are dealing with this, with the stigma. I was asked the question the other day, can
we find some people who would be willing HIV positive people who would be willing to talk
about HIV and aging on camera? I called in my care manager. I said, hey, listen,
I need to get about five
or six people and she just looked at me like girl, you're not about to get that. So we ended up engaging in a conversation
around is it stigma? What does it really mean? And it's not stigma, as in I'm ashamed. I'm embarrassed. I don't want anyone to know. But the normal life that people are living,
taking their meds compliant, having a great life that they -- there's no reason to upset
that by being vocal now, not against being vocal, they'll support you, but the normal
. And so how do we really talk even about stigma? Because they're not stigmatized. They're perfectly fine, but they're not interested
in having everyone look at them at Antioch Baptist Church on Sunday, that's not what
they want to do. And so for us, I think we're learning honestly
how to communicate this information better to you. So I'll share that I wish I had, I want you
to know this I'm still learning how to tell the rule story better. What is the data that really says to you. Oh my goodnes
s. We HCV is huge. So, when we test for HIV, we also do HCV screening
as well. And we had a partnership a few years ago with
the pharmaceutical company and when he looked at our data, he went, oh my God, did you know? No. Is it bad? And so, we're starting to -- that's why I
think I need -- we need more help with how do we interpret and communicate what's going
on in our space. How does it compare, maybe not in in actual
number, but in application in a particular area that's not an urban setting.
So we're claimed and I hope we can continue
to have that conversation and with the data that we're able to generate in a much more
robust fashion, be able to tell them a better story of our need, and of course, but then
also what we're doing really well that can be scaled up other places. >> Marvell Terry II: Thank you for the purpose
of time. We're going to double up on the questions. So, we have Carole and Duvia, am I pronouncing
it correctly? Okay, if you all can go together, ask your
questi
ons, then we'll get the panelist. >> Carole Treston: Mine is just a quick comment. First of all, thank you for putting together
such a smart and insightful panel. This has really been remarkable. There are two things that were highlighted
in this that I don't hear enough around these tables and that is the impact of climate change
and in particular housing and what that means, then downstream and then the other thing that
I don't often hear, and I'm really grateful to hear, is about the role of
hospitals and
hospital based care because that is the reality in many places and including rural settings. And so those partnerships that include hospitals,
we don't hear enough about. So thank you for that. >> Marvell Terry II: Thank you so much. >> Duvia Lozano: Thank you to our panel of
experts. My question was surrounding the Latinx community
and the trend, the immigration trend, are you seeing a higher demand as we see that
immigration is increasing in the state of Texas, are we seeing Lati
nx and other immigrants
placing a higher demand on the need for care for HIV services? What are some of those barriers that you're
seeing with uninsured, underinsured, and undocumented individuals and what are some of the recommendations
that PACHA can take back and elevate to our Secretary of Health and Human Services to
assist you in eliminating these barriers to care? >> Cordella Lyon: Thank you. Yesterday, you know, I talked about private
public partnerships that hospitals can engage in. And
one of our biggest partners, Gilead Sciences,
allowed us to overlay HCV testing on our already existing HIV platform, and we're grateful
for that, because then we extended that partnership into prevention where we're now identifying
people who have a reactive STI and interacting with them to get them into prevention, whatever
it looks like you be prep or something else and through these modalities, we are finding
ways to engage with the community at the level where they understand HIV and preve
ntion. We're also finding out what is a priority
to them? It's a priority to me to link somebody to
care or to do testing. Maybe somebody's priority is getting food
that day. Through our partnerships also yesterday, one
of our reps met with a group of Hispanic ladies at a Catholic Church and talked about sex
and STI. And, so Mr. Daniel Ramos, I don't know if
he's in the room. There he is. Thank you, Daniel. He went down to South County and he interacted
--we take the message to the people that s
ay we're not expecting people to find us. We do know there is an increase in the number
of immigrants who are in our community now. Everybody does not speak Spanish. We do understand that as well. So there is this -- there could be language
barriers for those who speak a different language as their native language. And as we go out and we find these groups
on Facebook and wherever they meet, some of them, they do meet in a setting where they're
doing. DSL. We understand that those are the advoca
tes
for the community and they're the ones who we want to speak with first. I say this all the time, building trust. Is that we go in, we let them tell them what
they -- tell us, what they need from us. We share the resources that we have. It's not all about HIV. It's about let us get to the common ground,
then we can start having other discussions. And so, we'll be meeting with the Facebook
group that are doing ESL, and that's another one of the issues that we can address with
people who do not
speak English as a first language is crafting grants so that those
who receive that funding can have space to help people learn English. Just be confident in English as a primary
language, because as an immigrant, I can tell you. We're not confident when we first get here
because we say things differently and we sound funny, but we do want to advocate for ourselves
and if we have those spaces where we can learn to be confident in speaking English, then
we become the advocates, not just for heal
thcare. We will speak to our landlord. We will speak to our school principals. We will seek a job that does not require English
-- Spanish as a language because yes, it's nice to have a Spanish provider, but how many
Spanish providers are we going to get? So why don't we teach people to be confident? These are very smart people, they're just
not confident in speaking English. So, creating that space, that space could
also help. And that is why we're going to the ESL spaces,
because maybe we too
will learn their language and then be better able connecting and communicating. So that's one of the things that we're doing
as a hospital because we're neutral. >> Marvell Terry II: Thank you, DeAndre and
Guillermo. No question, DeAndre. >> Deondre Moore: I have a comment. Is that okay? I'll try to be brief as I can. I just want to say thank you to these ladies,
to all of the entire panel. Samuel. Miss amores. Thank you all so much for being here. I want people to realize that Beaumont is
actua
lly a rural area, no matter how the state tries to define it, it takes me an hour to
get here. Mostly it's an hour and 30 minutes, but I
have sport mode on my car and and in Texas we do believe in 75 and 85 mile per hour freeways. So that's it and you will get pulled over
for not going fast enough here. So, but I say that to say because being home
and Beaumont when I left Beaumont at 18 years old to go off to college, I swore I was never
going back. It was too slow. There's nothing there for me.
When I got a positive diagnosis, I knew that
I couldn't go back because I didn't know the healthcare was going to be sufficient enough
for what I needed as a young black queer man in the South. But for some reason I can remember this, this
lady right here from Baptist Hospital to Miss Cordilla Lyon calling me one day it was coming
up on World AIDS Day 2015ish and I just launched this campaign and she said I want you to come
back to Beaumont from school, drive three hours down and come give a sp
eech for World
AIDS Day. I said okay, cool. I'm in college, you know. What are you paying? What's gonna -- and she said, oh, we don't
have funding, she said. She said, but what I can do is I can take
you to Carrabba's for lunch. And that's exactly what we did. And I came down, and we did that. But what was so innovative and interesting
around this time was that this lady had people on stage talking about Prep in Beaumont, when
people didn't even really know what HIV was. And she took the resourc
es that she had out
of her own money and stuff to make sure that she was able to make that impact and to watch
it grow over time and be so innovative. It's just remarkable. And then to Miss Dena, as someone who lived
all over the country. Like I said, I was never supposed to go back
to Beaumont, lived in Houston, lived in Dallas, lived in Atlanta. But something about Atlanta, baby, I was having
too much fun. I had to get back home. And so I did. I did come back home, but full transparent
moment
last year around this time. I resigned from my full-time job as a full
time employee with full benefits and everything, and so for the first time in my life, what
that meant for me was that I was no longer going to have access to insurance and I was
nervous about what that meant. And so, before I left Atlanta, I remember
going to my doctor, who is a black queer man in Atlanta, never saw anything like it before. I requested to see if they would provide me
with at least three months of medications
because I knew it was about to happen. I wouldn't have insurance. I wouldn't have access and so on and so forth. So they did it. And I can remember one day at my restaurant,
Miss Dena comes in and she's there. She starts talking about my health care. And like, hey, you know, where you going? I know you're here. And I actually lied. I said, well, I go to Atlanta when I can and
she looked at me and she said, and excuse my language, the fuck are you doing in Atlanta? She said, do you not know what
we have right
here in Beaumont, and I said, I mean, I know that there's clinics and stuff I said, but
I'm just afraid of going somewhere where I can, where I won't find anybody who looks
like me and who will understand me. And she says somebody's going to call you
tomorrow. You better answer that phone. And something about a black woman that's not
your Mama telling you what you're going to do, in the South, you just do it. That's just exactly what happens. I've had the same thing with Marlene c
alling
me before, I used to make these posts on Facebook. She called me one day. She spoke. I need you to come to my office. I don't even work for you, lady, but I'm on
my way. I'm coming. I guess I got to go. And we had to come to Jesus moment. And that's just what it is. But she did that and I got the call from 10
and I'm like, OK, they're making me an appointment. How am I going to tell them that I don't have
insurance? What will this mean for me? Go in the first person at the front desk. Bla
ck woman. OK, this is different. Cool. She knows everything she's talking about. She makes me feel welcome. Go into the into the doctor's office. Nurse that comes in. Latina woman makes me feel welcomed. I feel so, you know, inspired. I'm just thankful to be here in this moment. I'm like, OK, like, let's see what this doctor
is, what's going to be and then comes another lady a Black Lady comes outside. Then I got two nurses, she says. Hi, I'm your doctor. My doctor Maisha. She's sitting right ba
ck there. She's says I'm your doctor. And this lady sits down. Usually doctors don't have enough time to
sit down, but she took the moment to sit down and go over with me where I was, how I was
doing. Ask about my mental health and so on and so
forth. And they got me access to care. And so for the first time in my life, again,
I felt so welcome and I was able to get access to cure in a place that I thought was not
sufficient enough to take care of me, which is on my rule hometown, Beaumont, TX a
nd so. So you, miss Deena. Emma square. Do you want to say thank you for that? And I also want to note that. Miss Dena Hughes and Miss Gloria right here. Both came to my restaurant again and they
said we want to launch. We want to come here. We want to talk about HIV in this establishment. We want to come to our restaurant. We want to bring together a group of women
and we want to launch the Texas Black Women's Healthcare Initiative right here in this restaurant. Is that OK? And I look around sa
id hell, yeah, that's
OK that's it. We should absolutely do that. And so congratulations to you ladies for doing
that because last month they were able to bring together about 20, 25 plus women into
my restaurant where they had displays and they were actively talking about HIV in a
restaurant surrounded by other people. And that was really life changing. And so and I just want to again, but even
without the resources these ladies and in these rural areas are still making a difference
and impact
on so many people's lives. So thank you so much. >> Marvell Terry II: Awesome. Awesome. Can you help me celebrate this esteemed panel
that we've had today? >> Marvell Terry II: I will now turn it back
over to our Madam Chair. >> Marlene McNeese: Thank you, Marvell. You know when you're doing outstanding job
leading something. It turns into a full-time gig, so we will
call you again to facilitate important PACHA conversations. I appreciate you. I just wanted to take a moment before we go
into our
break to recognize an individual here in the Houston area. I started the day yesterday with describing
some of the artwork that you see around the room and in the hall. It's all part of an eight year long effort
initiated by Mr. Corey Garrett. Art on the streets, World AIDS Day Project
is a collaboration between a school district, the health department, community organizations,
all the artwork is created by local students. I've had folks ask me since yesterday is the
art for sale? Want to learn
more about the project? And as you know, extremely successful project
over five million impression generated since its inception and it's been presented at most
major conferences, NHO, APHA, NCSD. Cory, please stand up. Let the people recognize you. For those who are interested in the artwork,
talk to Corey. He's right there and
we will take a break. We will come back right at 10:50 and we will continue this amazing
conversation shifting into urban perspectives. Thank you, 10:50. >> Male Speak
er 1: Produced by the
US Department of Health and Human Services.
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