ViewPoint; Age of AIDS in Micronesia - Part 2

Part two of the age of AIDS in Micronesia a roundtable discussion on the HIV AIDS policy and procedures in Micronesia tonight on viewpoint. Viewpoint where the community spotlight shines on island ideas and issues beyond. The Western Pacific the only public affairs magazine show. Opened. The. View really. Now the host of viewpoint. Half a day and welcome to view point substituting for Jackie. Tonight we present part two and part what we began our examination of the growing in Micronesia

from a historical and cultural perspective. We are pleased to welcome a panel of community leaders and professionals to discuss Micronesia and the Pacific region policy and practice perspective. Our guests are actively involved in the ongoing local and regional efforts to address the present needs of people with HIV and AIDS and to prevent the further spread of HIV AIDS in the future. Thank you everyone for being part of this roundtable discussion. We really appreciate that you are here tonight to join us in this discussion about your role in the struggle against HIV and AIDS. Hi my name is Simeon killing. I work for salvation army. I'm the director of Family Services. I also work part time with that youth a foundation. I coordinate all the training with the. Education and Training Center with chip which is sponsored

by the University of Hawaii Education Training Center. And actually I'm the TV control program supervisor. My role with the Hib program is actually testing all patients with HIV and AIDS testing. And it's really important role since we all know the TV and is one of the most common cause infection in people living with AIDS or HIV. Half a day my name is Terry I could not I'm a social worker with medical social services at Department of Public Health and I'm also the president of the GLEN HUNT project that's the Guam HIV AIDS Network project. My name is Tim Dela Cruz I'm a graduate student at the University of one my clinician studies program. I'm the vice president of the one project. Great welcome addressing would be a troubling situation in the rest of Micronesia presents significant obstacles and challenges for public and private organizations. From your perspective what

are the major hurdles that HIV AIDS policy and practices must overcome. Tuberculosis is one of the most common cause infection for people living with AIDS or HIV. And I think one of the basic challenges that we face right now is encourage patients with TB to undergo HIV testing and it's really a challenge and important that they be tested because of the current faction. Been part of the surveillance for TB and HIV. We normally in New Caledonia and I'm proud to say that for cases last year we. Screened about close to 90 percent of our active TB cases for each for each test. Great. You know I think as a social worker working with HIV positive community I think it would have to be access to health care. Health care is really important if a client's not accessing health care then their expectancy their quality of life can be shortened or can be harmed in many ways. So access to health care is very

important and not just access to health care but access to medication medications that are specifically for the treatment of HIV and AIDS. Ideally it's it's in all our best interest in Micronesia to improve as well and surveillance systems surveillance systems allow us to uniform HRB surveillance systems where they allow us to paint a better picture a true picture of the epidemic in Micronesia for instance in Chewco. There are still confirmed and unconfirmed test and what that what what surveillance improve surveillance systems allow is for rapid response to the epidemic. And as well as it provides local and regional bodies to impact prevention and care efforts. And in accordance with that to you know how do you identify the populations that you need to serve. How do you identify the interventions that need to take place. If you're not getting confirmation for your HIV cases I speaking for the other islands in Micronesia I can

see that. There's a lot of the lack of education in the schools also the lack of leaders. You know getting involved in you know things like finding funding. And if I go on there's a long list they need to get involved with. Said surveillance video surveillance from the Pacific Islands and really get some advice on that very quickly. You know it's sort of a combination when we talk about interventions and we really want to be able to reach out into the community and create. Interventions such as educational pamphlets or what have you. We need to know what populations were actually need to target. Now we've done two great links to be able to identify these groups. And I think public health and and one project is an excellent job doing so but when we start working with many of our outer island communities what we definitely want to know is who's testing positive in a timely manner that way we can actually set up interventions and help out their

health system without the confirmation of an AIDS test or an HIV test. Clearly you can identify your interventions when make it difficult for a confirmation to occur in the audience. Presently some of our islands not all of them are able to actually do an HIV test and for those that can do an HIV test they have problems transporting the actual blood sample for confirmation or for a Western blot. And because of that actually there are islands that are out there that have several unconfirmed HIV antibody test. So in the U.S. national system of surveillance is basically showing that there's really no cases that are occurring in the outer island Pacific jurisdictions is that correct. That's correct. And as a result of that there's little funding little support from Teen People that we clearly need to have in order to put these interventions in place. Now we talk about it casually but the truth of the matter is these are people's lives. This is the quality of their lives. You know these are women of childbearing years and these are young young men and in some cases

even maybe some children. We need to have these interventions in place. We need to be able to confirm an antibody test not only for our general public our general information as far as interventions but for the quality of the life of that individual to be able to get them to access medications as well. So it seems like they are regionally to each other and the impact on surveillance is really critical. Absolutely. Ok so can you tell me in terms of the interventions what right now are are we doing so that the islands are at least on a minimal doing some type of prevention on a regional scale or on a regional scale actually what takes place on Guam actually impacts quite a number of our neighboring islands by providing certain services such as case management by providing education nutritional information and so forth actually. In essence it looks more appealing in the sense of health care to many people who are testing

positive as a result of that many to relocate to Guam to access health care and this is important in a broader range to what takes place here on Guam. I actually has quite an impact regionally you know by setting up an excellent website full of good information as to what's going on in the Pacific. This is vital information for people in other locations who are trying to decide if they want to even come to Guam for whatever reason. Now Guam as a hub has many visitors and many many people who do contractual work who pass through our doors on their way to the Philippines Thailand or what have you. Many of them don't are fearful of the fact that they may not be able to access medications while they're out here. So by making sure the policies and practices are in place and strengthening those we can actually get secure or encourage the community that yes we are on top of things that yes there is room for improvement. But yes warm is a hub and can provide services to people living with HIV and what can we do so that federal policy has changed in terms of having the Centers

for Disease Control and Health and Human Services recognize that the efforts here need to be strengthened. In my opinion it's a combination of things that we don't just look to CDC and say hey this is what we need but we look to our local leaders. You know this is election time and I think it's you know I've yet to hear a strong platform that really talks about health care. Now everybody wants to say health care is needed and needs to be improved. We all know that that's nothing new. So is education and so is a number of other things like public transit. But the point again we're talking about the quality of people's lives we're talking about the fact that people cannot access good quality health care that their lives are actually cut short. So what can we do we can get our leaders way more involved than what they are now. You know how many of them are really giving campaign messages that have meat to them. You know we talk about respect that's excellent. We talk about quality care and we talk about different things that our election people may do or be involved with but the point is you know where is the hard core

material that says these are the bills these are the policies this is what the leaders actually backed and this is what we've been able to do since that time. Where are successes and where are our challenges and I'm not getting that with many of our leaders. And so you know I I look to that to see what's available out there and which perhaps way that I might vote to change the subject. So we were looking at examining the policy and I think one of that is really to look at those policies that do exist. So is there any specific local policy that we should examine and or stranger or add. Well when we talk about policy we're also talking about practices. And one I think excellent practice I think that we're doing right now is being able to get women of child bearing years in for testing. And part of that is a team approach between CDC's HIV s t program and the maternal child health program. Also with public health this is when a woman test positive on her UCG test but

cannot X prenatal care access prenatal care we're able to give free prenatal care to this person as part of that prenatal care HIV testing is available. Everybody it's optional but it is encouraged for all women. And we do get an excellent response to it. And we have had women test positive through this route. Tuberculosis you also have to the TV program seems to be doing a great job to screen. Yes basically I mean majority of our TB case especially those with the age 18 to 44. The practice going about 95 percent of these cases and we really encourage them although some will say oh I don't practice these in Latin America high where I might get drugs but still if they have TB We encourage them to undergo HIV testing because of the infection that could possibly exist. And one thing that we always explain to them is that if they're HIV positive the treatment regimen is totally different from what the standard TV regimen would be for a patient. So based on that we we really

encourage them to undergo testing. One of the biggest controversies was condom distribution in the school. Would you like to touch on that. You know I always have an opinion on that. Well the bottom line actually in my opinion on that is the fact that anybody who's had sex with a condom knows that it doesn't feel as good as it is without a condom. So if anybody's going to come to me and say hey you shouldn't be promoting condom usage because it promotes sex I say wait a minute you know anybody who's had sex with a condom knows it's not as good as good so where do you get the idea that it encourages people condoms are not 100 percent effective but they do cut down on the transmission of not only HIV committee I gonna reassess listen though this is as long as it can be. This is an important tool. This is something that people can use in the privacy of their home. Condom usage should be made available in my opinion not only in a health care setting such as a school's clinic or nursing room. But even in other places that we would not necessarily talk

about condom usage and I know in many areas in the States a correctional facilities actually are talking about the need for condom distribution. Why not you know and you know we need to be actually reaching out to youth too because there's a great deal of injecting drug use and tattooing that's taking place. We need to bring the critical issues right into the school system right where the children are right where the youth are that we can start planting the seeds for a better foundation for these youth. You know we give them lots of wonderful things to learn which I know they will use as they get older. But the truth of the matter is they're not going to get older if they're not going to be able to have a healthy life. Well let's talk about what what's one's perspective on condom distribution. You know Bernie for the last 25 years we've been talking about AIDS. There is no cure for AIDS but in the same vein we've also been saying that this is a this is 100 percent preventable. And to touch on what Terry had said condoms plays a role as a tool in helping combat

HIV AIDS in our region. What we do with the gwan project is we provide free condoms free lubricants. We also provide free educational material. For for teachers and in the workplace if people are uncomfortable about talking about issues of HIV AIDS we do provide education presentations and to reach out to our students to reach out to students and to reach out to the community. In addition we also provide counseling free counseling testing and referral or assure testing it's confidential. We also in addition to to condom distribution one project supports positive folks. I think when you talk about HIV prevention you have to talk about care and you have to talk about care in terms of Terry brought up the discussion earlier that for positive folks one of the hurdles that really is and it manifests itself as a barrier is the access to quality care

and the equation of to talk about prevention you must talk about care. OK when and in line with that I agree. One project plays a very strong role and support in the community for condom usage not only male condom and female condoms as well. And we're not only pushing condoms which is really important but we're not pushing it by itself but we're pushing the education that goes behind that condom not only its proper use consistently every time but also the importance of the fact that it's not 100 percent safe and that people need to know exactly what they're what they're what they're using how they're using it and using it responsibly. And I say it not only really else but because we have female condoms as well. Now how about advocating for abstinence based programs have somehow been. Absolutely and that's something in the forefront I know we talk about condoms but before we talk about condoms Absolutely we do encourage all our communities whether it's youth women of childbearing years or other populations that they make sure that if they can practice abstinence and even if they want to come in and talk about what's making it difficult for them

to practice abstinence we are willing to listen on projects in a wonderful position to provide services after 5 o'clock and also on weekend which makes it an excellent alternative testing site. Wonderful. What has been an economic social and transportation hub for centuries. We even refer to ourselves as the gateway to Micronesia as we are the set of so much activity. What is HIV AIDS role regionally. So I mean you want to call it to help answer that. Well actually originally like I had mentioned earlier what takes place on Guam doesn't just stay on Guam it's kind of like a vegas commercial. And the truth of the matter is what we do and how well we do it is looked upon in many different places. You know an excellent website that's available offering information services and things like is always very important. And I think that's part of the NEC ism of what we want to do. I think our participation in the U.S. Conference on AIDS is really important but not only did we participate that we bring our issues to the table

and we discuss it with key people that attend these meetings on how we can better our community here and be more effective. So you know as you said once we go to Congress to collect I think it's time that we as a community seek out services and we go to collect our information and to strengthen our community out here. I know in shoot there is some activity going on as well with the AIDS education training center. Would you like to touch on that. Yes. She's being very active in terms of training clinicians doctors nurses and also health health professionals. People fight this training throughout the migrants and islands. They just finished one from in Niger or try and point being great and if you didn't they were here about a couple months ago. Also providing

training or community work with their population you're in Guam right. We have the opportunity to visit actually chook a couple of weeks ago and we had a chance to visit their hospital and their public health. We did what was called an environmental scan just to sort of get a better idea as to what services are available on shoot for our HIV community. And clearly one can be a support to our outer island neighbors more specifically. I think they have an excellent team of people that work at their public health departments and their hospital. I think they are burdened with an overwhelming amount of obstacles. We talk about policies. I think it would be even difficult to implement policy I mean why create it if you can implement it at this point. And I think they're faced with many obstacles a lot of it being financial same as all of us but a lot but a lot of it being policy as well. I think amongst the many things that I really feel that that that we

could work together as a team. The fact that there is a new HIV medications other than AZT available to this population was just overwhelming. I know that six U.S. Pacific Island jurisdictions has formed a coalition called pay jack which stands for the Pacific Island jurisdiction AIDS Action Group. And for about four years now they've been lobbying on a national level. And I think this kind of model has worked. Would you like to add any of this. And you have his being done by the post of island jurisdictions age action group has an excellent group of people represented from all the islands that come about and talk about the issues in the Pacific. I think the issues as far as medications and treatments to be available not only insured but to many of our other island neighbors is a crucial one and I think plays a major role. I know we have a good team of people Vickie Rael from CDC as well as a whole list of other people who are very active proactive and many of these island people actually getting leaders in

their community involved such as the outreach that took place in March from the public health hospital. These are the things that we like to see and it's excellent to have been working with this community. The nice thing about it is it's not only working with this community but it's made up of this community and that's vital because anybody knows the Pacific is the people who live in the Pacific. Since most of the HIV and AIDS resources and services for the region come from or administered through Guam. What impact has HIV had a health care system or health system. In my opinion it's had an incredible impact not only on Guam's but worldwide regionally. It has set a standard of healthcare for all kinds of sexually transmitted diseases as well as bored blood borne pathogens. I think it's brought a new policy. I think it's implemented education. I think that fact many years ago were 25 years into this epidemic. I mean it had lots of

time to to to make a difference even within the school system. OK well let's talk about what is working and not working now. Let's go through them. The organizations you guys serve what is working in your organization. And not working with. Yeah. A church kitchen and training center that's coming out of chook. If I'm not mistaken they have trained over 200 doctors nurses and other health professionals. They've gone out to even remote islands. Dave I mean this training continues on a I know basis you know why. What they're trying to do now is train other. Health professionals to become trainers. When that happens then you know they'll be more trainers to provide you know training for HIV and AIDS throughout the entire islands. The only obstacle they're facing now is you know funding specifically

now that you know you know with the other islands in Micronesia there are so many little islands and you know you don't need a boat and water to go around to provide the you know the training or the education. And with the cost of fuel rising now. It's even harder. So what they would need is some support from their leaders in terms of funding and they also have to get. Active in terms of going after grounds of Wyman's doing really good with you know going off to the ground so those are the kind of things that quad can help. You know the other islands in terms of like ground they should go after things like that. I know with our populations be immobile a very transition. We now have to prepare for a future ahead. So while I know it's a community based organizations so I know Tim you guys have been very actively involved in making sure you guys are prepped for preparing. Would you like to touch on those issues. Oh sure efforts.

What we've been able to do in one project is do a lot of community engagement and that is for one project as a nonprofit organization. We fill in the gaps that that because of how broad the disease the epidemic is we fill in the gaps that the government can't provide. And so I think. Part of part of Quine project's approach is to bring education into the community and that's a team approach between private nonprofit and government. And if we can do it in a very non-threatening manner manner something that that's very positive then that's the way we want to do it. We've managed to do it through projects such as the aids our response fashion compassion the Miss Pacific Khana queen of queens pageant. You know these are some really fun ways to get community involved and more importantly it's a way of doing it in a non-threatening way and that people can dialogue. And I have had many moms and dads come up to me and said you know when we when our child came home and said they went to this and

that and we said we talked about it with them and they seem like they really got information out of out of the fun activity that they went to outreach. It's a form of outreach it's ongoing and we want to get more of the educational messages in the community and I know that's something that one project strives for. Celia would you like to touch our public health efforts. I believe public health that we have really done so much also in education and by way of public service and ads and even with TV nature a view right now is sort of doing a lot of education to the community and not just testing alone but you know making sure that the public is informed and even with public health alone we have clinics special clinics right now that's ongoing. Even have testing done. Even after working hours and even during the weekends which I think which is really very good which brings out the best in public health that is their way of educating a community of what's going on in and be there for them you know. You know situation with time. OK

so what is not working. I think basically is there's a lot of of obstacles right now I think especially with HIV as far as shipping specimens off island special mislabeled as infectious and the share that we view TB as a matter of fact we're able to herd of this problem. But it's just a matter of I think working with the airline industry making sure that stuff are labeled properly because if the test can be done. I mean what sense is all this that we're doing this you have to have a confirmation test. And I think it's a matter of relieved government working closely with with CDC and the airline industry to make sure that policies are met and set as well. So you know things can be done appropriately. I'd like to thank each and everyone for being here tonight. And thanks for watching. We'll see you next time.