Southern Indian Health Council Addresses Syndemic in Rural California

Federal leaders recently visited the Southern Indian Health Council (SIHC) in Alpine, CA, to observe its efforts to help end the HIV, hepatitis C virus (HCV), and STI syndemic in Indian Country. SIHC is one of seven grantees in the Ending the HIV and HCV epidemics in Indian Country (ETHIC) Program, which is funded by the Ending the HIV Epidemic in the U.S. (EHE) initiative, Minority HIV/AIDS Fund. The cooperative agreements include testing, treatment, prevention, and education services.

Andrew Yu, MS, BSN, RN, ACRN, HIV/HCV/STI Clinical Coordinator, Division of Clinical and Community Services, Indian Health Service (IHS); Rick Haverkate (Sault Ste. Marie Tribe of Chippewa Indians), National HIV/HCV/STI Consultant, IHS; and CDR Michelle Sandoval-Rosario, DrPH, MPH, Office of Infectious Disease and HIV/AIDS Policy Region 9 Director and HIV.gov Deputy Director, Office of the Assistant Secretary for Health, HHS, saw the work in rural southern California first-hand. Mr. Yu said site visits are beneficial for both IHS and the grantees.

“For us, we get to see the environment, the neighborhood that the clinic is set in,” Mr. Yu said. “Seeing the communities first-hand gives us a better idea of some of the challenges and opportunities. For the grantees, it’s an opportunity for us to provide feedback in person and have much more of an engaging conversation.”

SIHC serves a seven-member tribal consortium that includes Barona, Campo, Ewiiaapaayp, Jamul, La Posta, Manzanita, and Viejas. An accredited and Federally Qualified Health Center, SIHC provides a full spectrum of programs and services supported by federal, state, and local funds. Medical services are offered by providers, registered nurses, and medical assistants.

Expanding Mobile Health Services

With its funding, SIHC aims to expand its Roaming Outpatient Access Mobile (ROAM) Program. Its mobile van currently provides care five days a week in five locations. SIHC’s leadership hopes to increase staff to offer late afternoon, evening, and weekend hours to accommodate students.

In rural areas like those served by SIHC, access to services can be difficult because of stigma or lack of transportation and providers.

“Having a mobile clinic that can come to your community is such an important part of the delivery of care that we provide,” Mr. Yu said. “This is a perfect example of how that need is being met.”

SIHC is considering more effective marketing and advertising strategies to increase community awareness of its services. SIHC’s leadership also hopes to hire a full-time nurse to run the program on the van. In the meantime, they have been filling the role with existing staff.

Finding Creative Solutions

The grantees are in year one of their three-year cooperative agreements. Mr. Yu said he hopes funding will be available to expand the ETHIC Program in the future.

“We’re hoping this is a first step into a larger pond where many other tribal and urban organizations can apply and get funded to do the work because we are very much still in the HIV, Hep C, STI, substance use syndrome, syndemic,” he said.

“We capped the programs at $200,000 annually. Although funding is limited, a lot can be done with very little,” Mr. Yu said. “It’s literally a van. One van can reach hundreds, if not thousands, of people who would not receive timely care otherwise. Nothing is too small. When thinking of communities and programs that haven’t applied for grants before, anything is possible. You just have to be creative.”