Transcript

January 23, 2008

Q: Welcome to Conversations on AIDS.gov. Each month on AIDS.gov we have conversations with government officials about HIV/AIDS issues. Today we’ll be speaking with Commander Scott Giberson from the Indian Health Service. Commander Giberson, welcome and thank you for joining us today.

Scott Giberson: It is good to be here. Thank you for the opportunity to discuss the IHS and the American Indian/Alaska native (AI/AI) population we serve.

Q: What is the IHS?

Scott Giberson: The Indian Health Service is an agency within that functions as the principal Federal health care provider and health advocate for American Indian and Alaska Natives. Our goal is to provide the quantity and quality of health services necessary to elevate the health status of American Indian and Alaska Natives to the highest possible level. This includes comprehensive and culturally acceptable services to over 560 federally recognized tribes across the US through a system of over 600 healthcare facilities, which provide care to 1.9 million American Indian and Alaska Natives primarily in service areas that are rural, isolated and underserved. These facilities are managed by the IHS directly or by Tribal governments. In addition, the IHS Urban Program provides some funding to 34 urban clinics since approximately one-half of the population reside in urban locations.

Q: What is your role at IHS?

Scott Giberson: I direct its national HIV Program; serve as the Agency’s primary HIV technical resource and liaison to external agencies and organizations. I’m responsible for managing multiple facets of our program from advocacy and policy to prevention strategies, interagency collaboration and quality of clinical care.

Q: Would you please give us an example of how IHS meets the care needs of the AI/AN people living with (or at risk of acquiring) HIV in the United States?

Scott Giberson: Absolutely. The IHS and Tribes primarily serve small, rural populations with mainly primary medical care and community-health services, relying on the private sector for much of the secondary and tertiary medical care. We have a variety of HIV services offered, which include prevention and outreach education, counseling and testing and even treatment and care in a few of our larger facilities. Nearly all of our facilities provide HIV counseling and screening services, however they also provide linkages to treatment and care outside of IHS via Ryan White centers or other health facilities to ensure access to HIV services.

Q: What types of programs and initiatives currently exist?

Scott Giberson: There are many ongoing initiatives. We continue to do a good job of screening our prenatal population and currently are working on some quality of care projects. We have developed a strategic plan and have commenced multiple interagency collaborations as well as partnerships with Native community-based organizations to maximize our resources. We do receive some funding to provide training to our providers, increase the amount of HIV screening offered, augment our surveillance efforts and develop an HIV telemedicine network for some of our facilities. As well, activities for the annual National Native HIV/AIDS Awareness Day take place each year. Other projects will commence in 2008 as we look forward to increased integrative efforts.

Q: What do you see as key factors to improving success of the program?

Scott Giberson: That's an excellent question since improvements can always be made. It is critical to relay the importance of resources. Without appropriate resources, American Indian and Alaska Natives will face additional challenges in accessing preventive services, treatment and care. Much like the general US population, we need to increase personal knowledge of HIV status. More people need to be screened - as a population health measure. We must recognize other risk factors that contribute to HIV transmission and integrate prevention messages and outreach to communities. We must also develop ways to increase access and linkages to HIV services. As well, opening up discussion about HIV and routinizing services are two steps toward normalization of HIV, which is needed to reduce stigma and increase uptake of our healthcare system.

Q: What actions would you like to see public health officials take or continue to take with regards to HIV/AIDS and the needs of AI and AN?

Scott Giberson: To answer that question, its important to note that American Indian and Alaska Natives are an incredibly diverse, culturally strong and tradition-rich population. We can learn much by embracing the community in our planning efforts. We encourage all officials to take a proactive look at how they partner with Tribes, community organizations and local IHS facilities. There is a lack of native-focused evidence-based interventions, which should improve with collaborative efforts. We should all think about how to better integrate services and share data, for the improvement of public health. We should continue to increase availability of screening coupled with ensuring confidentiality, cultural fluency and reduction of stigma and discrimination. For those that are HIV-positive, we must be aware of potential challenges for follow up and increase our linkages to sustain high quality care. Finally, we ask that officials not rely solely on the sheer number of American Indian and Alaska Natives with HIV, but rather consider all health disparities and vulnerabilities to more accurately determine and ultimately reduce the risk.

Q: Thank you for speaking with us today about the important work IHS is doing to help meet the needs of the American Indian and Alaska Natives with respect to HIV/AIDS. For more information on IHS, go to www.ihs.gov. Please visit AIDS.gov to view the transcript of this podcast. This podcast was created in partnership with the US Department of Health and Human Services Office of HIV/AIDS Policy, the managing entity of AIDS.gov.