Access to Culturally Competent Care for Patients Living with HIV/AIDS

  • Jodie Dionne-Odom
  • Loida Bonney
  • Carlos del Rio


Cultural competence is a term that has been increasingly used over the past decade to outline a certain principle of care often deemed as lacking in the American system of medical care. Although there is no agreed upon definition, the American Medical Association defines cultural competence as:

Knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences; self-awareness; knowledge of patient’s culture; and adaptation of skills.1

The principles of culturally competent care have been derived from a vast body of knowledge in medical anthropology outlining the relationship between illness, culture, and the individual. Some experts in this field have expressed concern about the “medicalization” of cultural competence into a set of skills and list of behaviors that need to be memorized to be practiced effectively. Because the topic is complex and unique to each patient, it is not well suited to rote memorization and can be difficult to teach. But within the HIV research community many insightful studies have been performed that outline disparities in care for minority populations and propose mechanisms to help bridge the divide between patient and provider and to inform the discussion of how best to teach cultural competence.


Cultural Competence Objective Structure Clinical Examination African American Patient Ancillary Service Interpreter Service 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Supported in part by an HIVMA/IDSA Minority Clinical Fellowship Award to Dr. Loida Bonney and by the NIH/NIAID Grant No. 2P30 AI 50409-09 (Emory Centers of AIDS Research).


  1. 1.
    Davis BJ and Voegtle KH. Culturally Competent Health Care for Adolescents: A Guide for Primary Health Care Providers. Chicago, IL. American Medical Association, 1994.Google Scholar
  2. 2.
    Kinsler JJ, Wong MD, Sayles JN,. The Effect of Perceived Stigma from a Health Care Provider on Access to Care Among a Low-Income HIV-Positive Population. AIDS Patient Care and STDs 2007, 21(8):584–592.PubMedCrossRefGoogle Scholar
  3. 3.
    CDC 2008. HIV/AIDS Surveillance Report 2006. vol 18. Table 1.
  4. 4.
    National Center for Health Statistics. National Vital Statistics Report 2002; vol 50(16):30.Google Scholar
  5. 5.
    Executive Summary Report of the Secretary’s Task Force on Black and Minority Health. 1985. Vol 1.
  6. 6.
    Mayberry RM, Mili F, and Ofili E. Racial and Ethnic Differences in Access to Medical Care. Medical Care Research and Review 2000;57:108–45.PubMedGoogle Scholar
  7. 7.
    Smigal C, Jemal A, Ward E,. Trends in Breast Cancer by Race and Ethnicity: Update 2006. CA: A Cancer Journal for Clinicians 2006;56:168–83.Google Scholar
  8. 8.
    Peterson ED, Shaw LK, DeLong ER,. Racial Variation in the Use of Coronary-Revascularization Procedures – Are the Differences Real? Do They Matter?. NEJM 1997;336:480–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Shapiro MF, Morton SC, McCaffrey EF,. Variations in the Care of HIV-Infected Adults in the United States. JAMA 1999;281:2305–15.PubMedCrossRefGoogle Scholar
  10. 10.
    Marks G, Crepaz N and Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006;20:1447–50.PubMedCrossRefGoogle Scholar
  11. 11.
    CDC Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings. MMWR 2006;55:1–17.Google Scholar
  12. 12.
    CDC HIV Testing Among Racial/Ethnic Minorities – US 1999. MMWR 2001;50:1054–8.Google Scholar
  13. 13.
    Sifakis F, Flynn CP, Metsch L,. HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex with Men – Five US Cities, June 2004–April 2005. MMWR 2005;54:597–601.Google Scholar
  14. 14.
    Mugavero MJ, Lin HY, Allison JJ,. Failure to Establish HIV Care: Characterizing the “No Show” Phenomenon. CID 2007;45:127–130.CrossRefGoogle Scholar
  15. 15.
    CDC Advancing HIV Prevention Fact Sheet. August 2006.
  16. 16.
    Milberg J, Sharma R, Scott F,. Factors Associated with Delays in Accessing HIV Primary Care in Rural Arkansas. AIDS Patient Care and STDs 2001;15:527–32.PubMedCrossRefGoogle Scholar
  17. 17.
    Cunningham CO, Sohler NL, Wong MD,. Utilization of Health Care Services in Hard-to-Reach Marginalized HIV-Infected Individuals. AIDS Patient Care and STDs 2007;21:177–86.PubMedCrossRefGoogle Scholar
  18. 18.
    Gardner LI, Metsch LR, Anderson-Mahoney P,. For the Antiretroviral Treatment and Access Study (ARTAS) Study Group. Efficacy of a Brief Case Management Intervention to Link Recently Diagnosed HIV-Infected Persons to Care. AIDS 2005;19:423–31.PubMedCrossRefGoogle Scholar
  19. 19.
    CARE Act Overview. US Department of Health and Human Services. July 2006.
  20. 20.
    Parham D and Conviser R. A Brief History of the Ryan White CARE Act in the USA and its Implications for Other Countries. AIDS Care 2002;14:S3–6.PubMedCrossRefGoogle Scholar
  21. 21.
    McKinney MM and Marconi KM. Delivering HIV Services to Vulnerable Populations: A Review of CARE Act-Funded Research. Public Health Reports 2002;117:99–113.PubMedCentralPubMedGoogle Scholar
  22. 22.
    Wood E, Montaner JS, Chan K,. Socioeconomic Status, Access to Triple Therapy, and Survival from HIV-Disease since 1996. AIDS 2002;16:2065–72.PubMedCrossRefGoogle Scholar
  23. 23.
    Turner BJ, Cunningham WE, Duan N,. Delayed Medical Care After Diagnosis in a US National Probability Sample of Persons Infected With Human Immunodeficiency Virus. Archives of Internal Medicine 2000;160:2614–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Mundy LM, Kalluri P, Meredith K,. Women with HIV Infection: A Model of University-Based Care, Training and Research. AIDS Care 2002;14:S95–107.PubMedCrossRefGoogle Scholar
  25. 25.
    Sherer R, Stieglitz K, Narra J,. HIV Multidisciplinary Teams Work: Support Services Improve Access to and Retention in HIV Primary Care. AIDS Care 2002;14:S31–44.PubMedCrossRefGoogle Scholar
  26. 26.
    Ashman JJ, Conviser R, and Pounds MB. Associations between HIV-positive Individuals’ Receipt of Ancillary Services and Medical Care Receipt and Retention. AIDS Care 2002;14:S109–118.PubMedCrossRefGoogle Scholar
  27. 27.
    Conviser R and Pounds MB. The Role of Ancillary Services in Client-Centered Systems of Care. AIDS Care 2002;14:S119–131.PubMedCrossRefGoogle Scholar
  28. 28.
    Giordano TP, Gifford AL, White AC,. Retention in Care: A Challenge to Survival with HIV Infection. Clinical Infectious Diseases 2007;44:1493–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Anderson LM, Scrimshaw SC, Fullilove MT,. Culturally Competent Healthcare Systems. American Journal of Preventive Medicine 2003;24:68–79.PubMedCrossRefGoogle Scholar
  30. 30.
    Sarver J and Baker D. Effect of Language Barriers on Follow Up Appointments After an Emergency Department Visit. Journal General Internal Medicine 2000;15:256–64.CrossRefGoogle Scholar
  31. 31.
    Baker DW, Hayes R and Fortier JP. Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients. Medical Care 1998;36:1461–70.PubMedCrossRefGoogle Scholar
  32. 32.
    Chng CL and Collins JR. Providing Culturally Competent HIV Prevention Programs. American Journal of Health Studies 2000;16:24–33.Google Scholar
  33. 33.
    Federman AD, Cook EF, Phillips RS. Intention to Discontinue Care Among Primary Care Patients 2001;16:668–74.Google Scholar
  34. 34.
    King WD, Wong MD, Shapiro MF,. Does Racial Concordance Between HIV positive Patients and Their Physicians Affect the Time to Receipt of a Protease Inhibitor? Journal of General Internal Medicine 2004;19:1146–53.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    HIVMA Awards New Minority Clinical Fellowships. IDSA News Summer 2007.
  36. 36.
    Stone, VE. Optimizing the Care of Minority Patients with HIV/AIDS. Clinical Infectious Diseases 2004;38:400–404.PubMedCrossRefGoogle Scholar
  37. 37.
    Satcher, D. Ethnic Disparities in Health: The Public’s Role in Working for Equality. PLoS medicine 2006;3:1683–5.CrossRefGoogle Scholar
  38. 38.
    Functions and Structure of a Medical School. Liaison Committee on Medical Education. June 2007.
  39. 39.
    Cultural Competence for Medical Students. American Association of Medical Colleges 2005.
  40. 40.
    Betancourt JR, Green AR, Carrillo JE, and Park ER. Cultural Competence and Health Care Disparities: Key Perspectives and Trends. Health Affairs 2005;24:499–505.PubMedCrossRefGoogle Scholar
  41. 41.
    Dogra N and Wass V. Can We Assess Students’ Awareness of Cultural Diversity? A Qualitative Study of Stakeholders’ Views. Medical Education 2006;40:682–90.PubMedCrossRefGoogle Scholar
  42. 42.
    Brotherton SE, Rockey PH, and Etzel SI. US Graduate Medical Education, 2003–2004. JAMA 2004;292:1032–37.PubMedCrossRefGoogle Scholar
  43. 43.
    Shapiro J, Hollingshead J, and Morrison EH. Primary Care Resident, Faculty and Patient Views of Barriers to Cultural Competence, and the Skills Needed to Overcome Them. Medical Education 2002;36:749–59.PubMedCrossRefGoogle Scholar
  44. 44.
    Brach C and Fraser I. Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model. Medical Care Research and Review 2000;57:181–219.PubMedGoogle Scholar
  45. 45.
    Rapp DE. Integrating Cultural Competency into the Undergraduate Medical Curriculum. Medical Education 2006;40:704–10.PubMedCrossRefGoogle Scholar
  46. 46.
    Betancourt JR, Green AR, and Carrillo JE. Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches. Field Report for the Commonwealth Fund. October 2002.Google Scholar
  47. 47.
    Godkin MA and Savageau JA. The Effect of a Global Multiculturalism Track on Cultural Competence of Preclinical Medical Students. Medical Student Education 2001;33:178–86.Google Scholar
  48. 48.
    Smith WR, Betancourt JR, Wynia MK,. For the Society of General Internal Medicine Health Disparities Task Force. Recommendations for Teaching about Racial and Ethnic Disparities in Health and Health Care. Annals of Internal Medicine 2007;147:654–665.PubMedCrossRefGoogle Scholar
  49. 49.
    Rogers J. Competency-Based Assessment and Cultural Compression in Medical Education: Lessons from Educational Anthropology. Medical Education 2005;39:1110–17.PubMedCrossRefGoogle Scholar
  50. 50.
    Carrillo JE, Green AR, and Betancourt JR. Cross-Cultural Primary Care: A Patient-Based Approach. Annals of Internal Medicine 1999;130:829–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Jodie Dionne-Odom
  • Loida Bonney
  • Carlos del Rio
    • 1
  1. 1.Department of Medicine, Division of Infectious DiseasesEmory University School of MedicineAtlantaUSA

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