RUNNING HEAD: CULMINATING EXPERIENCE Page 1

Culminating Experience

Final Paper

Judith Lubega

Los Angeles Pacific University

MPH 690

Week 8
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Abstract/Overview

My culminating experience with the San Diego County HIV Planning Group (HPG) has been at the

San Diego County Department of Health and Human Services Agency (SDHHS) located at 3851

Rosecrans Street, San Diego, Ca 92110-3134. I’ve been involved in some weekly meetings such as the

Priority Setting and Resource Allocation Committee meetings as well as the HPG Consumer

Committee meetings. These two-hour meetings are held in collaboration of both organizations. All the

planning meetings I’ve attended have happened on a weekday, from 3pm to 5pm in one of the

boardrooms at SDHHS. The reason for the meetings is for planning of strategies and activities to help

address the current HIV/AIDS and Sexually Transmitted Diseases (STD) prevalence in the county of

San Diego. The target populations are all people of all ages in the county, and the organization targets

people of every race, gender and sexual orientation. The role of HPG is designing HIV events, resource

allocation, addressing HIV issues and how to divide up available monies. The organization’s role is

also to review HIV-related statistics and data, and to promote the Ryan White program.
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Introduction

My culminating experience is choice #2: Evidence-Based Practice Review and it has to do with

HIV and STI incidents in San Diego county including areas closest to the border of U.S. and Mexico.

The rates of HIV among individuals in the county is still high, but the county along with organizations

such as the San Diego HIV planning group of (HPG) are on a mission to eradicate the disease. This is

being done by identifying individuals plagued with the disease, setting them up with care and seeing to

any other pertinent needs they may have such as transportation to their doctor appointments, help with

copay payments, and providing affordable housing.

Description of The History and Context of The Health Issue, Description of The Epidemiologic

Burden of The Health Issue, as Well as Its Impact on The Greater Population

HIV/AIDS incidents have increased steadily along the U.S./Mexico border cities in the last

couple of years. The increase in the disease is attributed to socio-economic factors faced by individuals

along the border and in the nearby cities. The department of public health is working to identify the

reasons for the existence of the disease on the border, but also to implement policy changes that

improve intervention methods to this vulnerable population. In San Diego county, “since the HIV

epidemic began, 30,785 individuals with HIV disease (either HIV or AIDS) have been reported to the

local health department… in 2016, 499 new HIV diagnoses were reported among county residents”

(San Diego County Department of Health and Human Services Agency, n.d., p. 7). Additionally,

according to the 2015 HIV statistics, the county of San Diego came in number two in the U.S. counties

with the largest HIV incidents (San Diego County Department of Health and Human Services Agency,

n.d., p. 7).

The San Diego County Health and Human Services (SDHHS) report also indicates that “the

percentage of cases with simultaneous diagnoses increased slightly over time…” (San Diego County

Department of Health and Human Services Agency, n.d., p. 10) due to late diagnosis and reporting
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issues. According to the HPG survey; “people living with HIV: 781 (75%) HIV negative/unaware/no

answer: 257 (25%)” (Planning services for people living with HIV/AIDS in San Diego, n.d.). Among

this number, it was also reported that almost 5% of individuals with a positive HIV status are not

accessing care, and almost 10% of individuals with HIV stated the fact that they had not been

compliant in consistently accessing care (Planning services for people living with HIV/AIDS in San

Diego, n.d.). The impact of HIV burden in San Diego county includes issues to do with care of the

children of adults with a positive HIV status. Additionally, is the issue of housing accommodations for

individuals with the disease along with their families. Another burden caused by HIV burden is the fact

that infected individuals also have other comorbidities along with HIV; with diseases such as mental

illness. This along with the lack of housing has increased homelessness among HIV patients in the

county.

Methodology

HPG is involved with reaching out to all people with HIV or at risk of acquiring it regardless of

age. The San Diego planning group was established to implement the “Ryan White

HIV/AIDS Treatment Extension Act of 2009 (RWTEA)” (Planning services for people living with

HIV/AIDS in San Diego, n.d.) mission of monitoring individuals with HIV in the county, and to

allocate monies and other resources for the good of improving the quality of life of individuals with the

disease. During the HPG meetings decisions are also made regarding which activities to include in the

community to encourage individuals with the disease to seek and remain under care. Other needs that

individuals with HIV might have are also assessed and plans are made on how to address those needs

(Planning services for people living with HIV/AIDS in San Diego, n.d.).

Description of Instruments/Tools (i.e., Surveys, Etc.) That Are Used by The Organization

The two sources used to collect data in San Diego county are “California Department of Public

Health Office of AIDS, eHARS – enhanced HIV/AIDS Reporting System” (Planning services for
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people living with HIV/AIDS in San Diego, n.d.) and “San Diego Association of Governments,

population data” (Planning services for people living with HIV/AIDS in San Diego, n.d.). Additionally,

the method used to determine who in the county are unaware of their HIV status is the “National HIV

behavioral Surveillance (NHBS) survey” (Planning services for people living with HIV/AIDS in San

Diego, n.d.). In order to determine CD4 depletion, San Diego county relies on the state of California to

calculate these figures using a formula. The CD4 depletion model provides data “indicating disease

progression or duration after infection, to estimate HIV incidence and prevalence…among adults and

adolescents (HIV surveillance Supplemental Report, p. 11).

Critical Analysis of The Culminating Experience And/or Accomplishments Related to The

Culminating Experience

During my attendance of the HPG meetings, I found it undeniable that the committee has a clear

burden to eradicate HIV/AIDS in the communities of San Diego and continue to involve HIV infected

individuals in the daily workings of HPG as an organization. During some of the meetings, it was

expressed by some consumers (committee members or meeting attendees with a positive HIV status)

that they weren’t being heard, and therefore felt no need to state their concerns because even when they

did, nothing would be done about any of the issues raised. This problem was acknowledged by a

representative from SDHHS along with consumer committee members that efforts would be made to

address concerns; and in fact, some of the consumers were called upon right then to air their

grievances.

In other meetings such as the Priority Setting and Resource Allocation Committee meetings

(PSRAC), the San Diego County HIV department representative when asked to give an update on the

Psychiatric Models of Care Task Force (PMCTF); stated that there were no meetings set as of yet

regarding this program. He stated that part of the problem and the lack of progress had to do with there

not being enough HIV infected individuals in need of psychiatric services partly because MediCal and
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the Affordable Care Act (ACA) both covered such services. PMCTF had been requested because of the

increase of psychiatric and mental issues plaguing individuals with HIV/AIDS; and the planning group

(HPG) wanted a task force to strategize and come up with a plan on how such needs would be met

among individuals with HV.

Description of The Potential Immediate and Long-Term Impact on The Target Population

The mission of HPG is to attain the “Getting to Zero (GTZ) Plan (aka the Integrated Plan)”

(Planning services for people living with HIV/AIDS in San Diego, n.d.) whose goal is to “1. Test, 2.

Treat, 3. Prevent 4. Engage and 5. Improve” (Planning services for people living with HIV/AIDS in

San Diego, n.d.). GTZ was established by the county of San Diego to “…end the HIV epidemic over

the next decade” (San Diego County Department of Health and Human Services Agency, n.d.).

Description of The Implications of The Professional Experience on Public Health Practice

As a result of my involvement with HPG, I’m more aware than before about the prevalence of

HIV not just along the border of the U.S. and Mexico, but inland within San Diego county.

Additionally, I’m more equipped with the understanding of what other needs individuals with HIV have

beyond the disease with such issues as comorbidities, housing and childcare. This knowledge is crucial

because is not enough just to design intervention programs for HIV, but it is also important to address

other issues which if neglected do negatively affect individuals with HIV and compromise their health

further.

5Ws (Who, What, When, Where, Why) of My Culminating Experience

Who?

Who Was Supporting The Culminating Experience (Leadership Within The Organization)? Who

Had Permission To Perform The Various Culminating Experience Activities?

HPG is open to the public. In other words, committee members can be either consumers; those

individuals in the community with a positive HIV status (also called HPG consumers), or they can be
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simply community members interested in participating in the planning and strategizing involved with

the HIV epidemic in San Diego county. In this case, I too had permission to participate in the planning

group meetings.

What?

What Were Your Goals And Objectives For The Culminating Experience?

My goal and objective for the culminating experience was initially to find out what

organizations were focused on addressing the HIV/AIDS and STD epidemic in San Diego County and

especially along the U.S. and Mexico border. HPG was the organization I found and I was interested in

learning more about what they were doing to help the HIV population in the county, and how they were

reaching their goals.

What Problems/Issues Did The Culminating Experience Address? Was This A Knowledge Gap

Or Was It A Working Solution To A Public Health Problem With A Publication In Mind?

A few issues that HPG addressed during the consumer meetings that were also working

solutions included the cost of care for HIV patients, stigma related to individuals having a positive HIV

status, and the fact that people with HIV don’t know how to get involved with HPG. Additionally, there

were concerns that when individuals joined HPG, they were unclear about their role in the group.

Regarding this issue, a recommendation was made that some kind of training be offered to consumers

and other interested parties in the public all in the effort of helping to boost attendance. Furthermore, it

was recommended that other training be done to educate both consumers and the public about how

HPG committees are selected and what laws govern the Ryan White program.

A gap identified during the HPG meetings was the fact that when individuals with a positive

HIV status are out of care, it’s difficult to get them back in care. Therefore, a recommendation was

made that Drop-In Clinics be set up to encourage people with high no-show rates to get back into care.

More funding was suggested and plans made to allocate it to help with efforts to encourage populations
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that were inconsistent in accessing care such as the African Americans to resume in HIV care as part of

the Outreach Services sector of HPG.

When?

When Was The Culminating Experience Expected To Take Place And For How Long? When

were the various time-based events, activities, etc. of the intended Culminating Experience?

The culminating experience does not have an end date because the HPG meetings are

continuous throughout the year. My regular involvement in this culminating experience is for the

duration of my MPH degree journey but will continue as scheduling permits. I’ve been involved in

some weekly meetings such as the Priority Setting & Resource Allocation Committee meetings as well

as the San Diego HIV Planning Group (HPG) Consumer Committee meetings. These two-hour

meetings are held in collaboration with the San Diego County Department of Health Public Health. All

the meetings I’ve attended have happened on a weekday, from 3pm to 5pm in one of the boardrooms at

the San Diego Health and Human Services Agency location.

Where?

Where Is the Identified Agency/Organization Where You Completed the Culminating

Experience? Where The Agency/Organization Was Located Graphically And/or Logistically

And/or Where Were The Logistical Aspects Of The Culminating Experience?

My culminating experience has been undertaken at the San Diego County Department of Health

and Human Services Agency (SDHHS) located at 3851 Rosecrans Street, San Diego, Ca 92110-3134.

The weekly meetings such as the Priority Setting and Resource Allocation Committee meetings as well

as the HPG Consumer Committee meetings are two hours long. All the meetings I’ve attended have

happened on a weekday, from 3pm to 5pm in one of the boardrooms at SDHHS.

How Did You Plan To Get The Most Out Of This Experience?

I firstly reviewed the HPG website and reviewed their mission and goals. I then contacted Kim
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Hodges, the HPG coordinator who explained to me what each meeting entailed. From the information I

gathered, I concluded that I needed to attend a few consumer committee meetings, and more Priority

Setting and Resource Allocation Committee meetings. From their events calendar, I planned weekly on

which meetings I would attend. Reading the meeting agendas and also reading the previous meeting

minutes helped familiarize me with the meeting formats, with the different committee members and

presenters; as well as consumers.

Why

Why Was the Culminating Experience (CE) Pursued? Address the Various Drivers and/or

Constraints (Internal and/or External) That Were Imposed Upon the Culminating Experience.

I pursued this CE for the purpose of understanding what was being done about the HIV/AIDS

and STD epidemic in San Diego County. The consumer committee meetings were led by HPG

committee members who also had a positive HIV status. Issues addressed included the need for

housing and transportation to doctor’s appointments for individuals with HIV. Such discussions seemed

to flow better during the Priority Setting and Resource Allocation Meetings where the chairman or

chairwoman was a physician, and the presenters where public health professionals specializing in HIV

care and prevention, and approached the subject matters more objectively. This was in comparison to

the HPG committee meetings which were also led by the consumers.

Were There Any Aspects Of Your Culminating Experience That You Could Not Complete? Why

Were These Aspects Required?

No, I had access to all that I desired to be exposed to in my culminating experience during the

meetings and discussions. There were different speakers, and presenters at the meetings who were HIV

specialists in some form and which allowed for well-rounded and balanced meetings with different

professionals in the field of public health. I was therefore able to ask questions, and found these

professionals very knowledgeable. Additionally, the inclusion of individuals with HIV in the planning
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and strategizing involved with HIV interventions provided realistic input in regards to the

recommendations made.

Implications of My Culminating Experience on My Professional Growth in the Field of Public

Health

As a result of my involvement with HPG, I’m more aware than before about the prevalence of

HIV not just along the border of the U.S. and Mexico, but inland within San Diego County. I’m also

more equipped with the understanding of what other needs individuals with HIV have beyond the

disease. Such issues include comorbidities, housing and childcare. This knowledge is crucial in that it is

not enough to design intervention programs for HIV; it is also important to address other issues which

if neglected do negatively affect individuals with HIV and compromise their health further.

Identification of At Least Two Takeaways That You Gained From This Experience That Were

Career-Enhancing

The first takeaway gained from my CE and that is career-enhancing is the understanding that

without addressing other needs and comorbidities facing the HIV impacted populations, the fight

against HIV/AIDS is limited. For example, HPG is involved in a plan to have the Psychiatric Models of

Care Task Force (PMCTF) to help come up with a plan to address psychiatric needs of HIV patients.

Additionally, HPG committees also allocate funds to housing needs and childcare needs for HIV

patients in order to improve their wellbeing. Secondly, HPG and the San Diego County AIDS office do

not include behavioral change in their HIV programs. Therefore, in my opinion, it is no wonder that the

rates of new diagnoses have remained the same. Another takeaway is the fact that there are many

people in the county who do not know their HIV status.

Conclusion

The Vision and Mission of the MPH program is “to give students the resources needed to make

a positive impact in the wellness of their communities” (Master of Public Health (MPH) Information
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Meeting Details, n.d.). This culminating experience is helping me learn the different aspects of the San

Diego County department of Aids; as well as how to plan and strategize to address the HIV epidemic.
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References

HIV surveillance Supplemental Report. Retrieved From:

https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-

report-vol-24-1.pdf

Master of Public Health (MPH) Information Meeting Details. (n.d.). Retrieved from

https://www.apu.edu/nursing/posts/26056/).

Planning services for people living with HIV/AIDS in San Diego. (n.d.). Retrieved from

http://www.sdplanning.org/

San Diego County Department of Health and Human Services Agency. (n.d.). Retrieved from

https://www.sandiegocounty.gov/content/sdc/hhsa.html