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Culturally appropriate integrated care is essential for the Adherence of Indigenous Persons Infected with HIV in Guatemala
Angel R. Solval, Lic. Janet M. Ikeda, M.A.
Norman Hearst, M.D., M.Ph.
Location of the Integrated Care Clinic ¨Dr. Issac Cohen Alcahé¨
Principal Areas where Indigenous Peoples live
Issue:Official AIDS cases in Guatemala are not
reported by ethnic groups.
There are a large percentage of persons living with HIV/AIDS that are from the Mayan ethnic groups.
Our hypothesis is that culture is the foundation for integrated care of Indigenous persons living with HIV.
Objetivo We implemented this study to describe concrete elements that secure cultural respect and can be integrated in adherence counseling for this underserved population.
Description:We implemented a study among 240 Indigenous
persons infected with HIV from the integrated care clinic in Quetzaltenango, Guatemala.
We designed, validated and administrated a structured questionnaire that measures: demography, experiences in HIV integrated care clinics, socioeconomic and cultural factors that influence in adherence and integrated care, the need to speak in the Indigenous language, concepts regarding sickness and health, spiritual and religious perceptions.
Characterization of Group: Ethnic Groups by sex
Maya Mestizo0%
10%
20%
30%
40%
50%
60%
70%
Maya; Male; 62%
Mestizo; Male; 55%
Maya; Female; 38%
Mestizo; Female; 45%
MaleFemale
Ethnic Group
Maya; Total; 194; 73%
Mestizo; Total; 70; 27%
Total
MayaMestizo
Preference and comprehension of language among Mayan peoples.
Maya; Series1; 83; 30%
Spanish; Series1; 194; 70%
MayaSpanish
OccupationInformal Sector; Series1; 66; 25%
Housewives; Series1; 56; 21%
Agricultural workers; Series1; 42; 16%
No employment; Series1; 42; 16%
Artesanal activities; Series1; 34; 13%
Construction; Series1; 22; 8% Student; Series1; 2; 1%
Informal SectorHousewivesAgricultural workersNo employmentArtesanal activitiesConstructionStudent
Promedio de ingreso mensual:
Q.729.00
Education
Incomplete prima-ry school; Series1;
95; 36%
No schooling; Series1; 94; 36%
Junior and High School; Series1;
34; 13%
Completed prima-ry school; Series1;
33; 13%
University; Series1; 8; 3%
Incomplete primary schoolNo schoolingJunior and High SchoolCompleted primary schoolUniversity
Religion
Evangelical; Series1; 153; 58%
Catholic; Series1; 72; 27%
None; Series1; 36; 14%
Other; Series1; 3; 1%
EvangelicalCatholicNoneOther
ART by Sex group
With ART Without ART0%
10%
20%
30%
40%
50%
60%
70%
80%
90%With ART; Female;
80%
Without ART; Female; 20%
With ART; Male; 81%
Without ART; Male; 19%
FemaleMale
Persons with ART by Ethnic Group
With ART
Without ART
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
MayaMestizo
Lessons Learned: Adherence Levels by ethnic group
No Adh
eren
ce to
ART
Little
Adh
eren
ce to
ART
Suspe
cted
no
com
plia
nce
to A
RT
Good
Adher
ence
to A
RT
0%
10%
20%
30%
40%
50%
60%
70%
80%
MestizoMaya
Lessons LearnedIt was necessary to explain HIV/AIDS, ART
treatment and the nature of ART medication in the Mayan language within the socio-cultural context of the person.
70% of the Indigenous patients manage a different concept of sickness and health than the western perspective. Sickness and health is based on communal perceptions rather than individualistic aspects.
How to interpret what it means to be HIV infected
Is part of life Challenge/Burden- Blame Accident that was wished upon
Common Disease0%
10%
20%
30%
40%
50%
60%
70%
MestizoMaya
Part of Life
CARGA or Challenge
There isn´t a feeling that anyone should be blamedThe person accepts their condition as HIV positive personActions are oriented to improve their future.
Is a responsabilityAn opportunity to raise their values to another levelTo devote themselves to self-careThey have a personal goal that their life will be useful and dedicated to serving others.It is their hope that they will become a great person and community leader.
Leaders(K’amal B’e)
Challenge/Candidates for Service
(Eqomal)
Sick Person (yawab’)
Lessons LearnedThere are persons in one´s life that can help
with the adherence.
Use religion or spirituality to improve ART treatment.
Recieve Family Assistance
Receive Assistance from the Family42%
44%
46%
48%
50%
52%
54%
MestizoMaya
Next StepsDialogue about HIV and AIDS as part of the
oral tradition, transmiting a vision of NO discrimination among HIV+ persons.
Advocate among leaders and community authorities to bring support to the integrated care HIV clinics (this includes assisting with adherence to HIV therapy)
Propose to other integrated care clinics to take steps in complementing the vision that the Indigenous populations have regarding sickness and health.
Thank You