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