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Date of Report: 06/16/2003
Source: Pacific AETC
For the past four years, the Hawaii AIDS Education and Training Center (HAETC) has been engaged in capacity building with the support of the Pacific AIDS Education and Training Center (PAETC). The targeted jurisdictions include American Samoa, Guam, Commonwealth of the Northern Mariana Islands (CNMI), Republic of Palau (RP), Republic of the Marshall Islands (RMI), and the Federated States of Micronesia (FSM). Each of the States in FSM, Yap, Chuuk, Pohnpei and Kosrae were treated as separate jurisdictions because of their distinct political and cultural structures, as well as their specific training needs. After an initial assessment, the HAETC developed a nine phase longitudinal strategy offering didactic training, on site HIV care consultation, offisland physician and nurse mini-residencies, distance-based learning, clinical consultation and the eventual development of regional training centers to serve the needs of FSM and the Marshall Islands.
The Hawaii AETC began this initiative with a commitment to ensure that the HIV training resources were close to the trainees. Chuuk was selected as the first in-region site because it had the support of other jurisdictions, the most HIV cases apart from Guam and Saipan, and the fewest resources.
The first lessons learned in this training initiative were those learned by the AETC faculty. To succeed, the faculty had to observe the local culture, which respected hierarchy and formality. Finding common ground required the AETC team to sit back, settle in, and listen to the respected members of the community, a challenge to the team's usual assertive approach.
Both culture and resource limitations influenced the content and format of the training. Male to male sex is not acknowledged, and sex is not discussed with someone of the opposite gender. Accordingly, males and females were trained separately to increase their comfort with discussing sexuality. Educational materials also had to be reconsidered. The common checklist approach to discussing sexual practices was scrapped, and a more culturally appropriate format was used to gain this essential information. Other challenges included the lack of gloves, bleach, routine laboratory tests, and HIV medications. Training requires realistic problem solving that acknowledges the lack of resources, provides guidance for making medical decisions, and focuses on palliative care.
In addition to training healthcare providers, there was a need to educate families with HIV infection. For example, it is a local custom for the family of the deceased to wash the body in preparation for burial. Even if gloves were available, families do not feel it is acceptable to use them. Families were educated on how to avoid body fluids, while still observing the necessary funeral rituals.
Like in the early days of the epidemic in the United States, the healthcare providers fear the transmission of HIV infection. The AETC faculty worked with the providers to address their fears, conveyed great respect for their willingness to serve their community despite these fears, and described them as "real heroes."
With small, but growing, numbers of patients with HIV infection, the model developed in the US Pacific-affiliated jurisdictions may be applicable for other low resource regions globally where education that is responsive to the culture of the local community is the primary healthcare tool.
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