HealthyCal.org

By Marnette Federis
California Health Report

Students at a San Jose college celebrated Asian American Heritage Month with song, dance performances and activities meant to increase awareness about sexual health.

Getting information out to this ethnic group is important, according to advocates, because the topics are taboo.

“From my experience, as an Asian American, these are topics we don’t about, it’s hush, hush,” said Ethan Giang, an HIV program specialist with the Asian Americans for Community Involvement, a group within the Asian HIV/AIDS Collaborative of Santa Clara, which sponsored the San Jose event. “HIV, sexual health and homophobia it’s all a part of that.”

Overall, the number of Asian and Pacific Islanders who are newly infected by HIV is small compared to other ethnicities—2 percent for Asians and 1 percent for American Indians and Native Hawaiians in 2009. In comparison that same year, 44 percent of new HIV infections were among African Americans, 20 percent Latinos and 32 percent among whites.

The event, held at Evergreen Valley College in south San Jose on May 10, is just one of dozens that was held around the world as part of National Asian and Pacific Islander HIV/AIDS Awareness Day on May 19.

At one table, students created cards with messages of hope for those who are living with HIV. At another table, students played a trivia game about HIV. Others held up signs about why they think it’s important to talk about the virus. Outside an assembly hall, students lined up to get free, confidential Rapid HIV Testing.

Organizers said the event was meant to be interactive and encourage people to talk about HIV and sexual health.

“We want it to be more engaging, since we are focused on raising awareness,” said Giang.

But public health workers and advocates say the infection rates within Asian and Pacific Islanders are increasing. In Santa Clara County, public health workers say the number of Asians and Pacific Islanders who are now being treated for HIV has risen.

“The percent of patient population of [Asian and Pacific Islander] descent was 4 percent and in the last 4 or 5 years it has doubled to 9 percent,” said Dena Dickinson, who manages the Ira Greene Partners in AIDS Care and Education Clinic, Santa Clara County’s main HIV/AIDS provider. “It’s out there, it’s people who are immigrating in, but it’s also people who have been here for awhile, men and women.”

Advocates say current infection numbers also may not reflect a clear picture about Asian and Pacific Islanders since testing rates within the group is the lowest out of any other ethnic groups. Over two-thirds of Asians and half of Pacific Islanders have never been tested for HIV. And for those who are living with the virus, one out of three don’t know that they are infected.

“It’s not just somebody else’s disease it’s very present in the [Asian and Pacific Islander] community,” said Dickinson. “We really have to stop thinking about, it’s this group or that group. It’s really everybody.”

One reason why many in the Asian and Pacific Islander communities are not getting tested is from fear of finding out results, said Jane Dalugdugan, a program manager with the San Francisco-based Asian and Pacific Islander Wellness Center. The fear of bringing their families shame is another stumbling block.

“If the results are positive, [they fear] they may lose their family, that their family may disown them … and that they may lose their friends,” said Dalugdugan.

She adds that misconceptions about the disease are rampant in Asian and Pacific Islander communities. According to surveys her organization has conducted, many believe those living with HIV shouldn’t be allowed to teach or prepare food at a restaurant, Dalugdugan said.

“We found it’s important to end stigma within our community, talking about the facts about HIV, promoting people getting tested, creating communities for those living with HIV [and connecting them with other] Asian and Pacific Islanders they can relate to,” said Dalugdugan.

Talking about HIV and sexual health within the group is more important today, advocates say, with the latest U.S. Census revealing that Asian Americans is the fast growing minority in the country.

“There’s no reason not to get tested,” said Supriya Rao, a clinical quality coordinator with the Santa Clara Public Health. “You can do it anonymous, it can be done in 20 minutes, and all the test counselors are trained to handle people from different cultures.”

One project that is aiming to combat stigma in the community is called Taking Root: Our Stories, Our Communities. The project, which is part of a national initiative, is a three-day workshop where people living with HIV tell their stories through audio, images and music. The narratives are compiled together and shown at community events across the Bay Area.

Nathan Manuson, a Filipino-American gay man who is living with HIV, was among those who participated in the workshop. He narrated a story about a close friend who died of AIDS, unable to tell anyone about what he was going through.

“So I hope that me sharing my story, [it] will change the community’s way of thinking,” said Manuson.

Culture is also a thread that runs through some of the stories.

Melenie Eleneke, who is transgender and Native Hawaiian, was among the participants living with HIV. She says that the workshop forced her to remember parts of her Native Hawaiian ancestry that she had since forgotten—that she comes from a long line of women healers. Focusing on this part of her story, Elenke says she has been able to accept and forgive herself for her actions and move forward.

“Maybe a part of my story can resonate with someone who cannot take accountability for their behavior and their actions and cannot forgive themselves,” said Elenke.

Advocates said they hope the stories will touch many in the Asian and Pacific Islander community and feel connected with the people who are telling their stories—helping them become less fearful about getting tested or about disclosing their status.

Project organizers are planning to bring the workshops to other cities around the Bay Area and incorporate stories not just from HIV patients but also family members, friends and those who care for someone living with HIV and AIDS.

By Mary Flynn
California Health Report

Black students in Oakland public schools face harsher discipline, miss more school, and are likelier to dropout than white males, according to new research.

The Urban Strategies Council conducted three studies analyzing data from the Oakland Unified School District (OUSD). The reports examined three areas – rates of suspension, chronic absenteeism, and dropout risk – that determine the success of its students, and further analyzed the data, breaking it down by race and gender.

The results were clear.

“African American males fare worse than any other gender and ethnic population,” said Urban Strategies Council CEO Junious Williams.

The Urban Strategies Council works in partnership with the school district and the East Bay Community Foundation as part of a larger initiative – the African American Male Achievement Initiative (AAMAI). The AAMAI that aims to enable black males to achieve their full potential by reversing academic and social inequalities.

Nearly one in five students of Oakland public schools is an African American male.

The research determined that during the 2010-2011 school years, 18 percent of African American males were suspended at least once, while only 3 percent of white males were suspended. This reflects a growing body of research that finds students of color are more likely to be expelled or suspended than their white counterparts, as healthycal.org recently reported.

A large number of the suspensions, 44 percent, were due to “willful defiance or disruption,” which researchers call a highly subjective offense.

“When you’re talking about something as vague as whether a young person has been defiant, especially when there’s no definition of what that means, you bring to bear the fact that we’ve got the most diverse student population we’ve ever had,” Williams said.

Williams gave the example of how growing up, it was expected in his household to ask questions of adults, whereas that type of behavior might not be acceptable to some teachers.

Williams suggests three possible explanations for the disparity, and he added that it is likely some combination of the three. It may be a difference in treatment – that the African American students are not behaving any differently, but they experience the hand of the system differently. He said it may be behavioral – that the students themselves act out more – or it could be “structural incompatibility” in that the school system is not being as culturally responsive to the needs and background of African American students and others in the population.

Williams said that the reports provided limited information into the variables of student backgrounds, things like socioeconomic status or family composition, that would provide more insight into the best way to intervene.

The analysis also revealed that nearly one in five African American males was chronically absent, missing more than ten percent of the school year. While the overall chronic absence rate in OUSD is high, the rate among black boys was almost twice that, and they were three times as likely to be chronically absent when compared to white boys.

According to Hedy Chang, Director of the non-profit Attendance Works, “the results illustrate the troubling and harsh reality that poor achievement and dropout for African American male students cab be traced back to especially high levels of chronic absence in kindergarten and first grade,” she said in a statement.

The report also found that one-third of African American males were off-course for graduating from high school. These findings were based on an analysis of key measures that varied by school level but included things like attendance, academic performance and suspension.

The warning signs were most prevalent among black males in middle school, where 55% displayed signs of dropout risk.

The reports make multiple recommendations for the district to implement. These include improvements to tracking disciplinary efforts that precede out-of-school suspensions (currently, these are unknown) and developing systems that allow for early interventions for students heading off course.

The district is already making efforts to improve educational outcomes for black male students. In 2010, the school district established an Office of African-American Male Achievement (AAMA) in an attempt to take a strategic approach to the challenges facing African American males, said Chris Chatmon, executive director of the AAMA.

To Chatmon, the information in the reports is nothing new, but he hopes it is a wake-up call for others.

“For me, it’s leveraging this information to create a greater sense of urgency both for folks in the system and for in the community to ask themselves, ‘what are you doing to serve black boys,” he said. “How are we as a community going to address what’s happening within this ecosystem?”

By Hannah Guzik
California Health Report

All of the receptionists at the 11 Ventura County Centers for Family Health speak Spanish — because they have to.

About 30 percent of the primary-care centers’ patients don’t speak English and likely wouldn’t have access regular medical care if it weren’t for bilingual offices. Approximately 70 percent of the patients prefer to speak Spanish, said Victor Dominguez, a family practice physician at the Santa Paula clinic and medical director for the centers.

“If you went to the Santa Paula clinic, you wouldn’t even think you’re at a clinic in the United States because everybody’s speaking Spanish all the time,” he said.

The growing number of immigrants from Mexico and other Spanish-speaking countries into Ventura County has led to a shortage of bilingual providers that the nonprofit Centers for Family Health are attempting to address.

“I truly believe the Centers for Family Health serves the needs of the underserved, because we serve everybody — we do not turn anyone away,” said Kimberly Bridges, assistant vice president of the centers.

In 2011, the centers saw 16,191 patients, about 2 percent of the county’s population.

Ventura County is divided between the wealthy enclaves of Thousand Oaks, Moorpark and Camarillo in the east and the working- and middle-class cities of Ventura, Oxnard and Santa Paula in the west. All but one of the centers, in Camarillo, are located in the western portion of the county.

The centers have charity-care programs for migrant workers, low-income families and those without health insurance, some of whom negotiate to make upfront cash payments. When the centers were established in 1994, they were among the only primary-care facilities in the county that accepted Medi-Cal, California’s Medicaid health insurance program, Bridges said.

The centers are run by Community Memorial Health System, which also operates two hospitals in Ventura and Ojai.

About 80 percent of the providers at the centers are fully bilingual, Bridges said. Nearly all of the others speak enough Spanish to communicate adequately with patients, she said.

“You pick it up,” Bridges said. “In order to give good care, you have to have these skills.”

Bridges, a former nurse, learned Spanish while working at Los Angeles County and University of Southern California Medical Center for 10 years beginning in 1992.

“I would point to my stomach and they would say ‘estómago,’” she said. “I really learned to speak Spanish from my patients — they taught me.”

Throughout Southern California, as the Spanish-speaking population grows, it’s becoming increasingly difficult to get a job in a health-care field without speaking the language, said Bridges, who has worked at the centers for the past eight years.

“It’s an ever-growing necessity, because everyone needs health care,” she said. “In Southern California, Spanish is the language that is becoming a close second to English. I don’t see that going away.”

The centers employ 55 physicians and 20 nurse practitioners and physician assistants. The centers also see a number of people who speak Mandarin, Korean and Filipino, so executives try to have some staff members that can speak those languages as well.

The nonprofit tries to ensure that fully bilingual centers are located in areas where large majorities of patients speak Spanish, such as Oxnard and the more rural cities of Santa Paula, Fillmore and Oak View where many migrant farm workers live. Every medicine pamphlet, registration form and health advisory the center distributes is printed in Spanish on the back side.

Alex Villasenor, a receptionist at a clinic on Vineyard Avenue in Oxnard, said he can often see the relief on patients faces when they learn that he and the doctors speak Spanish.

“Some of the patients come in and they’re looking around kind of cautiously,” he said. “They might acknowledge you in English, but when they actually ask questions, especially with the doctor, they do it in Spanish.”

Patients who don’t speak English fluently often want to discuss their health in their native language to make sure they fully express themselves, Dominguez said.

“I find that a lot of patients don’t feel comfortable communicating with a provider that doesn’t speak Spanish, because they don’t like to bring an interpreter into the room, and there are privacy issues associated with that,” he said. “Also it’s very important in terms of having good-quality care, so I can really get the whole history of a patient.”

Dominguez said he can identify with these patients, because his parents prefer to speak Spanish with health-care providers.

Being bilingual can save patients’ lives, preventing overdoses of medications and allowing for the correct diagnoses, he said.

“A lot of patients are on blood thinner and I have to go over the instructions a couple of times in Spanish — imagine if I didn’t speak Spanish,” he said. “It’s easy to have some sort of miscommunication that can put a patient in a situation that can cause them to bleed.”

There are cultural differences too that make patients more comfortable discussing their health with a Spanish-speaking doctor. At doctors’ offices in Mexico, patients typically don’t speak to a nurse or physician’s assistant first — they speak directly to the doctor, said Petra Luna, comprehensive perinatal services program manger for the centers.

Patients also usually pay only upfront in Mexico; they aren’t sent a bill later as they commonly are in the United States, she said.

“When they come here, they give you so many charges and patients don’t understand,” Luna said. “You have to pay at the clinic and the lab and to have a doctor read your results. Cost becomes an issue.”

Doctors at the centers also sometimes work with neighborhood priests, respected figures in the Mexican culture, to help encourage patients to take their medications or get preventative checkups.

“The priests will help us, and they can play a significant role in what patients are doing for their conditions,” Luna said. “There’s no prevention concept for a lot of these patients, so that’s something we’re trying to implement and integrate.”

Luna runs a Medi-Cal program for pregnant women, enabling them to receive prenatal check-ups, counseling and nutritional guidance. Understanding Mexican culture and traditions can be just as important as speaking the language in treating these patients, she said.

“Knowing the culture, the customs, the religions and trying to be sensitive to that is so important,” she said. “It makes the patients feel like people.”

By Julia Landau
California Health Report

Photo: Julia Landau/California Health Report

A rag-tag band of protesters is becoming familiar on the streets of Oakland and they’re not part of the Occupy movement. This miniature society, which has a “Hep C Free Oakland” as its goal, is a group of patient-volunteers and staff members from a medical clinic focused on treating hepatitis C in people with addiction problems.

The Organization to Achieve Solutions in Substance Abuse (OASIS), established in 1999, is a locus of hepatitis C research and education in Oakland. Its director, who was a young doctor working in an area methadone clinic, says she set up shop when she realized that about 95% of former injection-drug users had been exposed to the virus.

Out of the clinic a slew of health care activists were born. Hepatitis C became an emblem for improving care and access to marginalized populations. “Hep C Free Oakland” is essentially a public campaign to find patients like themselves, who won’t otherwise seek medical care.

The hepatitis C virus (HCV) is most widespread among individuals largely overlooked in national health surveys. Drug-addicted, mentally ill, homeless, and incarcerated people run the highest risk of getting—and passing on—the infection. Although it can be easily screened and much of the time cured, health experts estimate that over half the people who carry the virus in the U.S. do not know they have it.

Hepatitis C earned the nickname “the silent killer,” because it often lays dormant for decades without triggering symptoms in the people who have it. But lately the virus has been flaring up. Aging baby boomers who became infected decades ago are experiencing hep C-related liver problems, attracting national attention, if not funds. Hepatitis C is now the leading cause of liver disease, liver cancer, and cirrhosis leading to transplantation.

Of those infected, roughly a third eventually experience serious liver damage. Those who don’t get sick, however, can still pass it on.

People who inject drugs are extremely likely to have been exposed to the virus, given its high prevalence and easy transmission—HCV can live in tiny drop of blood for days, and travel in other paraphernalia like spoons or rinse water.

Hep C now kills more Americans than HIV, causing more than 15,000 deaths every year since 2007, according to a February CDC report.

With that in mind, the patient-activists and their doctor — internist and addiction specialist Diana Sylvestre — chose methadone clinics as an appropriate launching pad for the awareness campaign. Cooperating methadone clinics have allowed activists to test and educate on the premises, turning the waiting rooms into sites for a mobile health care campaign.

For Sylvestre and others like her, wanting to test and treat “hard to reach” populations, waiting for patients to come to them isn’t always an option. It’s an effort that depends largely on volunteer, non-professional health care workers and cheap tools like poster board and buttons.

“Since hepatitis C is our specialty,” says Sylvestre, “we thought we should get rid of it in our own backyard.” Organizers pointed out that in the last ten years, testing sites and resources have grown despite the dearth of public health funds dedicated to hep C.

“It’s very word-of-mouth, what we’re doing,” says Larry Galindo, an OASIS staffer who has battled hep C since his Marine Corps days in the 1970s. “Nobody in Oakland who has hep C should be without care.”

In February, the OASIS group staged its first in a series of public demonstrations to shape perceptions about hepatitis C. The band of roughly 30 encompasses a range of addictions, mental and physical health problems, and splintered family histories. But the patient-activists say these challenging social circumstances are precisely what make them effective in fighting hepatitis C, which they call a “disease of the marginalized.”

Chanting ‘Get Hepatitis C Out of Oakland,’ the group left the 14th street methadone clinic for Lake Merritt, ending up around a mobile testing van on the far side of the lake. On the day of the first march, three out of the five Oakland residents who approached the mobile van showed exposure to hep C.

Predictions made in the journal Nature and elsewhere say 150,000 Americans will die from viral hepatitis in the next decade. While awareness grows, advocates say they would be thankful for a sliver of annual government funding provided for HIV. Over $2 billion in federal money went to HIV treatment last year, while less than $70 million subsidized hep C care.

Last year, the musicians Natalie Cole and Greg Allman went public with their hepatitis C infections, from using needles “back in the day.” Though Allman says his was a tattoo needle, the celebrity endorsements kindled more national activism.

A few years ago, hep C advocates half-jokingly called themselves the “unwanted stepchildren of infectious disease.” Now, Chavez says, that is starting to change.

The Berkeley Free Clinic is offering free hep-C testing on May 19 from 2-10 p.m. at 2339 Durant St. For more information about the testing, call 510 548-2570 Ext. 2223.

Infographics by Natalie Jones, reporting by Mary Flynn
California Health Report

Where you live determines your health. This idea has been steadily gaining traction as emerging research continues to highlight the connection between place, lifespan and quality of life. As healthycal.org recently reported, for instance, researchers have found that stress can get under your skin and that violence can alter a child’s DNA. The poorest counties in California have the worst health, while the richest, generally, have the best.

This series of info-graphics looks at the stressors identified by residents in one low-income, high-crime area in the city of Hayward in Alameda County. The Jackson Triangle neighborhood recently won a “Promise grant” from the federal government as part of a program intended to improve the life chances of Jackson Triangle residents.

The grant is significant: only five were awarded in this first round, and the Hayward group beat out more than 200 other organizations in 45 states for this grant (more will be awarded at the end of 2012).

The Hayward Promise Neighborhood (HPN) grant supplies $25 million dollars over five years to provide services to successfully get kids “from cradle to career,” by address the issues that might keep a child from getting a quality education, including health, safety and stability. In the Jackson Triangle, students lack adequate study spaces, the classrooms are overcrowded, and many residents live at or below the poverty level. The HPN aims to cultivate an environment where the schools become the hub of the community, and wraparound services – childcare, parent education, improvements to recreation facilities or bike paths, counseling – help kids realize their potential.

Researchers conducted several community surveys and hosted multiple community forums to collect the information they needed for the promise neighborhood application. Residents consistently expressed concern for neighborhood safety. Data available for 2009 and 2010 indicated a high number of burglaries, vandalism and stolen vehicles in the neighborhood. One survey participant said their biggest concern was “making sure my children can play outside without me worrying about crime or bad people around my home.”

Overall, Alameda county has a high rate of violent crime. Experts say residents in high crime areas have increased stress levels, which may contribute to other health problems, including obesity, heart disease, or asthma. Additionally, residents who perceive their neighborhoods as dangerous may isolate themselves, and lack the necessary social support to cope with the stressors they face.

“I would say the Jackson Triangle is an area where people will avoid if they don’t have to come that way,” said resident Larry Romer. When asked what would most likely get in the way of their child going to college, the fourth most popular answer among survey respondents was drugs and gangs.

The Jackson Triangle community faces high levels of poverty. The cost of housing is so high, and incomes are so low, that nearly a third of the residents contribute more than half their income to housing. Additionally, many of the homes are crowded. More than half of these 591 poverty-stricken households are families with children. The median income for the Jackson Triangle is $48,267, an exceptionally low amount given the high cost of living in the Bay Area (the median income of Alameda county is $66,937).

Unemployment in the area is widespread. Resident Larry Romer said that there used to be a few larger companies – a cannery and a car manufacturing plant – that had employed many people. “People have lost their jobs in these big companies that have closed,” he said. “It’s hard for them to go out there and find jobs so that they can continue to live a decent life. And definitely in the Jackson Triangle, there’s a lot of people without work and that’s the hard part. When they worked at one place their whole life, and now they don’t even know where to go.”

Louise Townsend runs a daycare facility in the Triangle, and she says that even those who do have jobs have a hard time paying for childcare. “There’s a lot of moms who are struggling, and they’re single moms who really need to work to support their family, and they don’t qualify for daycare and maybe they’re on the waiting list,” she said.

Teenage pregnancy rates in Jackson Triangle are significantly higher than the surrounding areas. Pregnant teens are more likely to postpone prenatal care, often receiving late or no care before delivering. They are also more prone to developing gestational hypertension or anemia, and they are more likely to deliver their babies pre-term, which can result in developmental delay, illness or death.

The Promise Neighborhood grant aims to support the community “from cradle to career,” with the goal of creating a college-going culture. Teen pregnancy affects that continuum at two points – the teenage mother and the child. “It really impacts the success of these teens to be able to continue on and graduate not only from high school, but to move on to college, “ said Andrew Kevy, the Hayward Promise Neighborhood Program Manager. Additionally, he said, the program wants to be able to give kids the best start possible, something that is harder to accomplish with a teenage parent.

The issue of kids bringing weapons to school is nothing new, nor is it specific to the Jackson Triangle, but it is a concern. Studies have demonstrated that the presence of weapons at school can foster an intimidating and threatening atmosphere, making it difficult for kids to learn, and for teachers to teach.

This data is taken from the California Healthy Kids Survey, a voluntary survey administered to kids in grades 5, 7, 9 and 11, and it is intended to provide a brief snapshot of school climate.

“It speaks to a lack of connection that kids have to school and the stress level they’re under,” Kevy said. “If your basic needs aren’t being met and you’re not feeling safe and supported at school, you can’t focus enough of your energy on learning and mastering materials.”

The numbers of teenagers feeling sad, hopeless or contemplating suicide were shocking to the research teams, according to Kevy. This data was also compiled from the California Healthy Kids Survey, which demonstrated that these mental health indicators were similar to the statewide results.

“Anecdotally, that’s what we’ve seen,” Kevy said. “Parents are very hopeful for their kids, but we weren’t necessarily seeing a lot of that same hopefulness from the kids themselves, that they would graduate and achieve and go off to greatness.”

He said that optimism among the families varied – some felt hopeful that a school-centered community would succeed and change things, “but a number felt very disconnected with the schools and didn’t necessarily see the school as a way out for their kids.”

Kevy thought that an overall sentiment of hopelessness, particularly in kids, was likely a result of the environment in which they find themselves. “That’s easy to perpetuate when you don’t have a lot of success,” he said. “We’re really trying to break that cycle,” he said.