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Marginalized/Vulnerable Populations

Marginalized Populations are defined as: diverse populations such as Lesbians, Gay, Bisexual, Transsexuals; Incarcerated and Newly Released; Migrants; Immigrants; Seniors; Pregnant Women; Homeless; English as a Second Language communities; Dually and Triply Diagnosed.

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The following resources are available from the AETC Capitol Region Telehealth Project's Knowledge Center as well as repository locations of our collaborative partners. Materials are listed with most recent items first.

What's New

Adolescents

What's New

African Americans/Blacks

  • African-Americans' Perceptions of Health Care Provider Cultural Competence that Promote HIV Medical Self-Care and Antiretroviral Medication Adherence. 
    Findings of this study indicate the need for increased attention to the role of cultural competence in HIV/AIDS care. Understanding patient perceptions of provider cultural competence has the potential to improve HIV treatment adherence and health outcomes. Findings of this study indicate the need for increased attention to the role of cultural competence in HIV/AIDS care. Understanding patient perceptions of provider cultural competence has the potential to improve HIV treatment adherence and health outcomes. Source: PubMed 2013
  • Fact Sheet: Black Americans and HIV/AIDS. This updated fact sheet highlights the epidemic's impact on Black Americans, providing current data and trends over time.
    Source Kaiser Family Foundation 2013
  • Black Americans and HIV/AIDS Fact Sheet
    Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time
    Source: KFF July 2012
  • Back of the Line: The State of AIDS Among Black Gay Men in America 2012
    Comprehensive report outlines the health crisis among Black MSM including health disparities, healthcare barriers and risks, and strategies for change going forward. The report includes data, a timeline of events, articles, interviews and more. Follow the link above to read the full report.
    Source: Black AIDS Institute
  • HIV/AIDS Prevention Education: Developing Cultural Competent Programs for African Americans
    The purpose of this exploratory theory-based article is to discuss the extent of the HIV/AIDS epidemic in the African American community, variables that contribute to HIV/AIDS among African Americans, and culturally relevant program designs and instructional strategies that support African Americans' prevention needs and demonstrate respect for their cultural and family values. Source: PubMed 2012
  • Black Americans and HIV/AIDS Fact Sheet
    Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time
    Source: KFF 2011
What's New

American Indians/Alaska Natives

What's New
  • Use this link to access the latest citations about Arab Americans and HIV/AIDS fom PubMed, the National Library of Medicine's database of biomedical literature.

Arab Americans

What's New

Asian Americans

Health Literacy

What's New

Hispanics/Latinos

What's New
  • Use this link to access the latest citations about Homelessness and HIV/AIDS fom PubMed, the National Library of Medicine's database of biomedical literature.

Homelessness and HIV/AIDS

  • Improving the Health of the Homeless: Advice for Physicians.
    Homeless individuals suffer from a constellation of health issues, experience barriers to medical care that are both recognizable and hidden, and score worse on measures of health outcomes than the general population. The article   describes common conditions affecting homeless people and discusses how patient-centered comprehensive primary care, collaboration between health care providers and social service organizations, and innovative delivery of medical respite services can result in better care for this population. Source: PubMed 2012
  • Addressing Cultural and Linguistic Competence in the HCH (Health Care Homeless) Setting: A Brief Guide. HCH providers are sensitive to their client's attitudes,beliefs, and behaviors, many of which are shaped by their direct experience of poverty and homelessness. 2011
  • Use of Complementary & Alternative Therapies in Homeless Health Care. This issue of Healing Hands explains what is meant by CAM, describes the major theoretical systems and practices it comprises, and discusses therapies currently used by Health Care for the Homeless (HCH) practitioners—including nutritional supplements, acupuncture, and mindfulness-based stress reduction—and the extent to which their efficacy has been tested.
What's New

Incarcerated Patients Living with HIV/AIDS

What's New

Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ)

  • Health Equity Series: Responding to LGBT Health Disparities. Examines how LGBT individuals in Missouri and across the country experience poorer health outcomes than their heterosexual peers.
    Source: The Missouri Foundation for Health 2012
  • Lesbian, Gay, Bisexual, and Transgender Health Fact Sheet 2012. This factsheet explains why Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives.
    Source Healthy People 2020
  • Top Health Issues for LGBT Populations Information & Resource Kit informs health care providers and prevention specialists about the health experiences of LGBT populations. Understanding the health issues of LGBT individuals is a significant step in improving access to care and the quality of behavioral health services.
    Source: SAMHSA 2012
  • Why Gather Data On Sexual Orientation and Gender Identity in CLinical Settings
    This report explains that gathering sexual orientation and gender identity data from patients is essential to providing appropriate health care to lesbian, gay, bisexual and transgender (LGBT) people, who face significant documented health disparities. It also helps providers to better understand these disparities.
    Source: The Fenway Institute 2012
  • How to Gather Data On Sexual Orientation and Gender Identity in Clinical Settings
    This brief discusses two methods for gathering sexual orientation and gender identity from patients, by asking questions on the patient registration (intake) form, and by requiring that providers gather this information directly from patients during medical visits, recording responses in the electronic medical record.
    Source: The Fenway Institute 2012
  • HIV Infection among Transgender People
    Transgender communities in the United States are among the groups at highest risk for HIV infection. Transgender people are gender identity minorities.   The term gender identity refers to a person’s basic sense of self, of identifying as male, female, or some other gender
    (e.g., transgender, bigender, intersex).
    Source: CDC 2011
  • Effective Response
    AIDS: the Early Years and CDC's Response
    Supplements
    October 7, 2011 / 60(04);64-69 MMWR (1). The article summarizes CDC response to AIDS from the initial 1981 MMWR description of five cases of Pneumocystis carinii pneumonia (PCP) among homosexual men in Los Angeles- the first published report about an illness that would become known as acquired immunodeficiency syndrome (AIDS)-to the first International Conference on AIDS held in 1985. The authors recommend applying lessons from these early years to the future: 1) the importance of surveillance, 2) rapid identification of the causal agent, 3) innovations in diagnostics and treatment, 4) emphasis on prevention, and 5) importance  of personal commitment to advocacy, research, and clinical care quality.
    Source: PubMed 2011
  • Gay and Bisexual Men's Health CDC 2011
    This article addresses homophobia, stigma, and discrimination and its continued negative affect on the health and well-being of gay, bisexual, other men who have sex with men (MSM), and other members of the LGBT community. The article discusses how these issues affect health care access and service quality.
  • The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding
    The Institute of Medicine released this consensus report to develop a more complete picture of the health status of people who are LGBT and to identify research gaps.
    Source: Pubmed 2011
  • When health care isn’t caring
    This survey is the first to examine refusal of care and barriers to health care among LGTB and HIV communities on a national scale.
    Source: Lambda 2011
  • Challenges associated with HIV in transgender patients
    This article explores issues associated with transgenderism in the setting of HIV/AIDS, including the use of hormones along with antiretroviral agents and medications for treatment of opportunistic infections and a best practice model recommended to increase awareness among HIV providers and to improve cultural competency, sensitivity, and clinical capacity among all levels of HIV care providers.
    Source: deltaaetc.org 2011
  • Identifying the Needs of LGBTQ Immigrants and Refugees in Southern Arizona
    This article presents findings on the quality of service provision provided to this very underserved community pertaining to health care.
    Source: PubMed 2011
  • Culturally Competent Care for GLBT People: Recommendations for Health Care Providers
    This document provides simple and specific recommendations for health care providers to make their practice more welcoming for LBGT patients
    Source: KC 2011
What's New
  • Use this link to access the latest citations about MSM and HIV/AIDS fom PubMed, the National Library of Medicine's database of biomedical literature. PubMed
  • More about PubMed

Men who have Sex with Men (MSM)

Mental Health

  • Mental Health of Deaf People.
    In this article discrepancies are described  between a high burden of common mental health disorders and barriers to health care. Research into factors affecting mental health of deaf children shows that early access to effective communication with family members and peers is desirable. Improved access to health and mental health care can be achieved by provision of specialist services with professionals trained to directly communicate with deaf people and with sign-language interpreters. Source: PubMed 2012
  • Assessing the Mental Health Needs and Barriers to Care among a Diverse Sample of Asian American Older Adults.
    The study sought to compare the prevalence rates of mental distress of Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese older adults (aged 55 and older) to that of non-Hispanic whites; and to examine subgroup differences in utilization of mental health services. The findings of the study  not only highlighted the unmet mental health needs among older Asian Americans, but also illustrated significant variations among the various Asian subgroups. Source: PubMed 2011
  • Language Concordance and Patient-physician Communication regarding Mental Health Needs.
    This article discusses language-related communication barriers between minority patients and their physicians may contribute to racial and ethnic disparities in mental health care. Accordingly, the current study sought to examine whether perceived mental health needs and discussion of these needs differed as a function of race or ethnicity and language concordance in older Latinos and Asian and Pacific Islanders (APIs). There were no significant differences in respondents' perceptions of their mental health needs across race or ethnicity or level of language concordance status (Ps > .41), although there were significant differences in whether respondents had discussed their mental health needs with their physicians according to participant race or ethnicity and language concordance status (adjusted odds ratio = 0.47, P = .04). These findings underscore the importance of overcoming language-related and cultural barriers to improve patient-provider discussions of older adults' mental health needs. Source: PubMed 2011
What's New

Migrant and Immigrant Communities

Multimedia: Videos to View

What's New

Muslim Americans

What's New

Native Hawaiians/Pacific Islanders

What's New

Over 50

  • Top Health Issues for LGBT Populations Information & Resource Kit
    This publication informs health care providers and prevention specialists about the health experiences of LGBT populations. Source: SAMHSA 2012
  • A systematic review of education for the prevention of HIV/AIDS among older Adults,  PubMed 2012
    Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk.
    Source: PubMed 2012
  • Inclusive Services for LGBT Older Adults:  A Practical to Guide to Creating a Welcoming Agencies NRC on LGBT Aging
    This guide was created to answer these questions and help you as service providers to
    understand the unique barriers that LGBT older adults face, as well as the many ways
    to improve and expand the continuum of care and services available
    Source: PubMed 2012
  • A systematic review of education for the prevention of HIV/AIDS among older adults
    The authors conducted a systematic literature review on primary prevention of HIV/AIDS among adults aged 50 and older.  They summarize challenges to prevention, clinical guidelines, and HIV/AIDS education models. The authors conclude that additional research on effective prevention and additional outreach efforts are needed to provide adequate services to people in this age group.
    Source: PubMed 2012
  • The National HIV/AIDS and Aging Awareness Day (NHAAAD), observed on September 18. National HIV/AIDS and Aging Awareness day focuses on the challenging issues facing the aging population with regards to HIV prevention, testing, care and treatment. In addition, there is an increased need for prevention, research, and data targeting the aging population, medical understanding of the aging process and its impact on HIV/AIDS. Resources: AIDS Institute. The AIDS Institute: Announces over twenty registered events for the 5th annual National HIV/AIDS and Aging Awareness Day (NHAAAD).
  • HIV/AIDS and Older Adults: Fact Versus Fiction
    This article talks about the many myths and misconceptions surround HIV and AIDS, particularly for people over 50 living with the disease. HIV and AIDS have long been subject to many myths and misconceptions, many of which concern older adults. Thanks to recent advancements in HIV/AIDS treatments, particularly highly active antiretroviral therapies (HAART), many people living with HIV/AIDS are living long, healthy lives, transforming HIV into a chronic but manageable illness. Therefore, it is no surprise that research shows that adults age 50 and over comprise a significant—and growing—number of people living with HIV/AIDS (PLWHA), as well as those newly diagnosed with HIV and AIDS each year. Source: NRC-LGBT Aging 2011
  • What's Hard About Living with HIV/AIDS When You're Over 50? 2011
    Source: PubMed 2011
  • "I'm not going to die from the AIDS": resilience in aging with HIV disease
    This study seeks to examine the lived experiences of older adults with HIV/AIDS as it relates to strengths and resilience in dealing with this devastating disease.
    Source: Pubmed 2011
  • HIV/AIDS interventions in an aging U.S. population
    HIV prevention for people over 50 is an important health concern, especially as the U.S. population grows older. This article reviews the current interventions and proposes possible HIV/AIDS prevention effort for older adults.
    Source: Pubmed 2011
  • Religion, spirituality, and older adults with HIV: critical personal and social resources for an aging epidemic
    This paper presents a model of barriers to successful aging with HIV, along with a discussion of how spirituality and religiousness may help people overcome these barriers. From this synthesis, implications for practice and research to improve the quality of life of this aging population are provided.
    Source: Pubmed 2011
  • What do we know about older adults and HIV? A review of social and behavioral literature
    This review assesses the state of knowledge of the sociocultural and behavioral factors associated with aging with HIV.
    Source: Pubmed 2011
  • A Tool for Serving Diverse Communities US Administration on Aging
    This Toolkit provides the Aging Network and its partners with replicable and easy-to-use methods for providing respectful, inclusive, and sensitive services for any diverse community….
    Source: USAA
What's New

Pediatrics

What's New

Physically Challenged

What's New

Racial/Ethnic Minorities

What's New

Refugees

  • Identifying the needs of LGBTQ immigrants and refugees in Southern Arizona
    This article reports on the results of a needs assessment conducted for lesbian, gay, bisexual, transgender, and queer (LGBTQ) immigrants, asylees, refugees, and their allies in Southern Arizona. It is the first study of its kind in the United States. The most significant result of this study is that respondents perceived that providers lacked awareness of LGBTQ culture and did not provide culturally competent care.
    PubMed 2011
  • Refugee resettlement to the United States: recommendations for a new approach
    This article compares outcomes of resettlement strategies for two Laotian immigrant populations: Hmong and Thai Dam. Authors discuss the prevalence of psychosocial challenges faced by many Hmong immigrants to the United States, including difficulties with acculturation, welfare dependency, psychiatric disorder, mistrust, malignant youth gangs, and violence. These issues are much less prevalence among members of the Thai Dam tribal group. Strategies used for resettlement of these two groups differed greatly. Based on these differences, the author recommends a refugee resettlement strategy aimed at improved mental health and optimal acculturation for future refugee groups.
    PubMed  Aug, 2011
  • Overcoming health literacy barriers: a model for action
    A large influx of Indonesian immigrants seeking asylum from racial and religious persecution alerted providers in a New Hampshire community to the need for specific cultural knowledge about this ethnic group, in order to provide effective care. The providers sought to develop health education programs that provided knowledge and tools to overcome misunderstandings between providers and clients. The goal was to improve communication, improve health literacy, and prevent health disparities. A framework to understand factors that affect health literacy for local Indonesian asylum seekers guided community health education. Written educational materials for programs informed providers about health literacy barriers for this population. Community outreach engaged local pastors and interpreters as cultural brokers who collaborated with nurses to develop and implement culturally sensitive programs.
    PubMed  2011
  • Barriers to health care access among refugee asylum seekers
    Asylum seekers have poor access to health care. Qualitative data portraying their experience is lacking. Authors conducted focus groups and interviews with 35 asylum seekers, and 15 care providers and advocates, mostly male and mostly from African countries.  The study identified several barriers to care, which they categorized as internal (mental illness, fatalism), structural (service availability, food, shelter, and employment insecurity), and social assimilation barriers (system navigation difficulty, inadequate community support). The authors make recommendations for improving access, including promoting community-based organizations, enforcing the use of trained medical interpreters, and improving cultural competency.
    PubMed May 2011
  • Cultural competence among nurse practitioners working with asylum seekers
    Asylum seekers often have complex medical needs. Little is known about the cultural competences health care providers should have in their contact with asylum seekers in order to meet their needs. This study explores the cultural competencies that nurse practitioners working with asylum seekers thought were important. Results showed that participants thought providers should have knowledge of several key factors in the country of origin: the political situation, judicial context, and common diseases. In addition, providers should understand the effects of refugeehood on health, be able to deal with asylum seekers' traumatic experiences, and be able to explain the host country's health care system. Using interpretation services was also reported to be critical.
    Source: PubMed Nov 2010
  • Screening for HIV-Infection During the Refugee Domestic Medical Examination
    This paper summarizes Centers for Disease Control and Prevention (CDC) guidelines regarding HIV screening for refugees.  Since January 4th, 2010 refugees are not screened for HIV prior to arrival in the U.S. Current CDC guidelines recommend that all persons between 13 and 64 years of age be screened for HIV in health care settings. CDC also encourages screening for people of all ages. CDC recommends screening for HIV-2 for refugees who test positive for HIV and who may have been exposed in identified high-risk African countries. CDC recommends opt-out screening as part of the domestic screening examination. Guidelines emphasize the importance of cultural and linguistic competence in providing testing, diagnostic, treatment, and referral services.
    CDC April, 2012
What's New

Substance Use/Abuse

  • The urgency of providing comprehensive and integrated treatment for substance abusers with HIV
    Substance abuse is linked to many new cases of HIV infection. Barriers such as the myth that drug users cannot adhere to HIV/AIDS treatment block progress in curbing the spread of HIV in that population. This article explains the need to aggressively seek out high-risk, hard-to-reach substance abusers and to offer them HIV testing, access to treatment, and the necessary support to remain in treatment--both for HIV and for substance abuse.
    Source: Pubmed 2011
  • Alcohol use among patients with HIV infection
    Source: Pubmed
    This study evaluates alcohol use in patients with HIV infection, assesses ethnic and social associations, and describes outcomes.Source: Pubmed
    Source: Pubmed 2011
  • Alcohol/drug exposure, HIV-related sexual risk among urban American Indian and Alaska Native Youth: evidence from a national survey
    Migration of the native populations from reservations to the urban areas has resulted in mixed ethnicities of American Indian/Alaskan Native (AIAN) children. Minority youth require special attention and services in urban schools as they disproportionately experience poverty, low educational attainment, unemployment, and single-parent status.
    Source: Pubmed 2011
  • Unmet Needs Assessment Report: Ryan White Part A New Haven-Fairfield Counties Transitional Grant Area
    This report was developed to help determine service gaps and barriers in the continuum of care for Persons Living with HIV/AIDS (PLWH/A). Results of this client-centered activity are used to establish service priorities, document the need for specific services, determine barriers to accessing care, provide baseline data for comprehensive planning, including capacity building, and help providers improve the access and quality of service, especially to Severe Need Groups (SNGs)1 including IDUs.
    Source: The New Haven-Fairfield Ryan White-HIV Health Services Planning Council and Yale University
  • CIRA Research Summary
    A summary of the major findings of many CIRA affiliated research projects in “user-friendly” language regarding barriers to care for substance abuse patients living with HIV as well as other HIV prevention research for drug users.
    Source: Yale University in New Haven, The Institute for Community Research (ICR) and the Hispanic Health Council (HHC), both in Hartford, Connecticut
  • How will we welcome them Home? Addressing the Needs of Returning Soldiers and their Families suggests several culturally sensitive approaches to providing care to the Veteran
    No date
What's New

Veterans

  • Websites Focused on Veterans:
  • National HIV/AIDS Strategy Operational Plan 2011
    The National HIV/AIDS Strategy Operational Plan was designed to promote a coordinated effort between Federal agencies, community organizations, and other health care settings to respond to the domestic HIV epidemic. The three primary goals of the strategy include:  Reducing the n umber of Veterans who become infected with HIV; Increasing access to care and improving health outcomes for Veterans living with HIV; and reducing HIV-related health disparities. 2011
What's New

Women

  • Addressing the Intersection of HIV/AIDS, Violence against Women and Girls, & Gender–Related Health Disparities. This interagency federal working group report outlines recommendations that explore HIV/AIDS, violence against women and girls, and gender-related health disparities.
    Source: White House 2013.
  • Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges. To inform the development of the state health insurance Exchanges under the Affordable Care Act, this checklist identifies key coverage, affordability and access issues that are important for women. Based on lessons learned from women’s health research and the Massachusetts experience, the checklist considers essential health benefits, implementation of no-cost preventive services including contraception, provider networks and affordability, outreach and enrollment efforts, and the importance of including gender and other demographic characteristics in data collection and reporting standards.
    Source: Kaiser Family Foundation 2013
  • Fact Sheet: Women and HIV/AIDS in the United States. This updated fact sheet highlights the impact of HIV/AIDS on women in the United States, providing current data and trends over time.
    Source: Kaiser Family Foundation 2013
  • Confronting the Crisis 2012: Women and HIV Conference: November 1 - 2, 2012
    Rutgers University, Student Center; New Brunswick, NJ
    This conference will provide education and networking opportunities for women living with HIV/AIDS, care providers, researchers, and policy makers. Focus topics include: care and treatment, prevention, policy/advocacy, social and reproductive justice, co-morbidities, and wellness.
  • Women and HIV/AIDS in the United States  Fact Sheet
    Women have been affected by HIV/AIDS since the beginning of the epidemic, an impact that has grown over time. Women of color, particularly Black women, have been especially hard hit and represent the majority of new HIV infections and AIDS diagnoses among women, and the majority of women living with the disease
    Source: KFF July 2012
  • National Women & Girls HIV/AIDS Awareness Day is March 10.
    Women have been affected by HIV/AIDS since the beginning of the epidemic, an impact that has grown over time. In partnership with Community Education Group, Greater Than AIDS is mobilizing women and girls to increase knowledge about HIV/AIDS and confront the stigma surrounding the disease.
  • Care for women with HIV: gender perspectives
    When women face social and cultural inequality they inevitably bear increased HIV infection risks. The success of antiretroviral therapies in suppressing HIV's viral load and prolonging patient lives has made HIV a treatable chronic disease. Given the same follow-up treatments, research shows no significant differences between men and women in terms of either clinical, immunological or virological parameters at baseline or mortality after one year of antiretroviral therapy. Gender equality is essential to effective HIV prevention. Nurses must take all appropriate measures to eliminate discrimination against women in HIV prevention, treatment and care programs in order to ensure equal gender access to critical healthcare services.
    Source: PubMed December 2011
  • YOUR Blessed Health: an HIV-prevention program bridging faith and public health communities.
    African American faith-based institutions are not necessarily equipped to balance their moral and spiritual missions and interpretation of religious doctrine with complex health issues such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). YOUR Blessed Health (YBH) is a faith-based, six-month pilot project designed to increase the capacity of faith-based institutions and faith leaders to communicate about and address HIV/AIDS and sexually transmitted infections (STIs) in 11- to 19-year-old African Americans. In addition to increasing the knowledge and skills of young people, the intervention seeks to change churches' norms to provide more open settings where young people can talk with faith leaders about sex, relationships, STIs, and HIV/AIDS. YBH expands the roles of adult faith leaders, particularly pastors' spouses, to include health education as they implement the intervention in their congregations and communities. The intervention includes a flexible menu of activities for faith leaders to select from according to their institutional beliefs, doctrines, and culture.
    Source: PubMed January-February 2011
  • Efficacy of a Health Educator-Delivered HIV Prevention Intervention for Latina Women: A Randomized Controlled Trial
    This study developed and assessed AMIGAS (Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally congruent HIV prevention intervention for Latina women adapted from SiSTA (Sistas Informing Sistas about Topics on AIDS), an intervention for African American women.
    Source: Pubmed 2011
  • Keeping Our Hearts from Touching the Ground: HIV/AIDS in American Indian and Alaska Native Women
    HIV/AIDS is a critical and growing challenge to American Indian and Alaska Native (AIAN) women's health. Conceptually guided by the Indigenist Stress-Coping Model, this paper explores the historical and contemporary factors implicated in the HIV epidemic among AIAN women and the co-occurring epidemics of sexual violence and substance abuse.
    Source: Pubmed 2011
  • Women and HIV/AIDS in the United States KFF Fact Sheet 2011
    Women of color, particularly Black women, have been especially hard hit and represent the majority of new HIV infections and AIDS diagnoses among women
    Source: KFF 2011

 


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