‘Latino men are not just going to walk into our doors’: Tobe discusses how DAP Health is working with Latino men

By Robert Hopwood, DAP Health

Across the nation, HIV cases have decreased in white men, but they have increased in Latino men.

In the Coachella Valley, DAP Health also has seen the number of HIV cases in Latino men under the age of 40 increase, says C.J. Tobe, Director of Community Health and Sexual Wellness Services at DAP Health.

Locally, since 2019, about 25% of new HIV cases have been Latino men under the age of 40, according to DAP Health data.

In light of Palm Springs' demographics, the fact that a quarter of new HIV cases are Latino men under the age of 40 is a lot, Tobe says.

Tobe says those numbers also result from DAP Health's work of engaging that community and ensuring they have access to education and testing specifically the new HIV self testing program where over 30% of self testers have been latino men.

DAP Health has found that while Latino men under the age of 40 may get diagnosed with HIV in a mobile clinic at a health fair in Indio, for example, they would have gone years without an HIV test, or even knowing they were living with HIV, if DAP Health had not brought services to them in the east valley, Tobe says.

"Latino men are not just going to walk into our doors until it's too late, Tobe says.

Social determinants of health like poverty are driving new HIV infections in the east valley, Tobe says.

More: C.J. Tobe: Success of DAP Health’s mobile clinic occurs every time it is in the community

Related: C.J. Tobe

Related: DAP Health’s Commitment to Health Equity

DAP Health can correlate HIV rates with poverty, he says. The majority of Latino men under 40 who are newly diagnosed with HIV live below 200% of the federal poverty level. For a single person, that is $25,760.

Poverty is a significant driver of everything to do with HIV, Tobe says. People with minimal or no income are not going to prioritize routine HIV testing or take preventative medication like PrEP (pre-exposure prophylaxis), or consistently use condoms.

"It also leads to people having survival sex. Sex for shelter, sex for food, or having sex to make money, to be able to afford those things they need, which also puts them at risk for HIV," Tobe says.

Another contributing factor to HIV infections is cultural, Tobe says. Sex is not something people talk about openly. Some men may still be in the closet, or they could be on the "down low” or “discreet.” It is challenging for men who have not accepted their fluid sexuality to acknowledge their sexual health should be a priority such as getting tested for HIV and STDS and take PrEP and consistently use condoms. 

Tobe says DAP Health is doing many things to reach this population, including:

• Sending free self HIV test kits to anyone who requests one;
• Advertising on bus shelters across the valley;
• Confidentially providing people with education and community resources;
• Setting up health tables in areas with Latino populations;
• Providing support to Riverside County and their substance use and mental health departments;
• Working with four recovery centers in the east valley;
• Attending area events like The Flying Doctors, El Grito Festival, East Coachella Valley Pride, and the Indio Open Air Market;
• California Care Force;
• Working with the John J. Benoit Detention Center in Indio, the re-entry program, and the Coachella Valley Rescue Mission; and
• Attending Latin Nights at Coachella Valley clubs.

‘It's a very important element of creating safe spaces’: Velasco talks about pronouns

By Robert Hopwood, DAP Health

Pronouns affirm the humanity of an individual and help reduce stigma and obstacles to health care. In short, they matter.

They create a safe space for patients.

"They are a simple and basic topic, but they have a big impact on many of our patients," says Anthony Velasco, Senior Nurse Practitioner Specialist at DAP Health.

Velasco provides comprehensive gender-affirming care at DAP Health, and he advocates for creating better access to safe and gender-affirming spaces for all. He also co-chairs DAP Health's Transgender Health Program.

One of the most important steps to creating a welcoming environment for transgender and gender-diverse people is to address patients using their preferred names and pronouns, according to the Centers for Disease Control and Prevention.

Velasco says that using the wrong pronoun to refer to someone is almost like calling somebody by a different name than the name they use.

A pronoun is a word that replaces a noun. For example, the words "it" or "that" are pronouns. Personal pronouns — he, her, they, etc. — are words that refer to a person.

They are a simple way of validating a person's gender identity, creating safe spaces for patients.

Sex is binary and assigned to a person at birth. Gender, on the other hand, is a social construct and is not necessarily the same as the person's sex that was assigned at birth. It isn't binary.

"When I introduce myself and introduce my pronouns to someone, it creates a signal for that particular individual that it is safe for them to discuss their gender identity with me and any gender-affirming needs they may have, especially during our visit," Velasco says.

The 2015 U.S. Transgender Survey — the largest survey ever devoted to the lives and experiences of trans people — surveyed nearly 28,000 people about discrimination, stigma, and health disparities among transgender and gender-diverse people.

They found that 33% of respondents reported having at least one stigma-related experience when they tried to access healthcare. Velasco says that the experience and expression of stigma includes verbal abuse, assault, or even refusal of care.

More: Transgender Care at DAP Is Here For You 

On YouTube: BORN TO BE: Panel discussion and Q&A

In the same study, they found that a significant number of transgender and gender-diverse adults avoided accessing health care services because of the stigma related to discrimination.

Velasco says that when somebody does not acknowledge their gender identity — by misgendering them or deadnaming them — that could be perceived as a form of discrimination.

In another recent study, Velasco mentioned, more than 90 percent of transgender and gender-diverse people in the Inland Empire had health insurance. But most of them didn't access care because they couldn't find a competent provider in providing gender-affirming care.

"One of those incompetencies or lack of knowledge and training would be not validating people, not using correct pronouns, not being aware of gender-affirming issues that transgender and gender diverse people need," Velasco says.

By doing simple, concrete things like making sure we have ways to identify people's pronouns and their chosen names, DAP Health can prevent those barriers to care, Velasco says.

"By us not using and acknowledging their gender identity, by us not using their chosen name — their pronouns — this could potentially limit their access to care," Velasco says.

He says other ways — beyond the use of pronouns — clinicians can let trans people know they provide affirming care is by:

• Using gender-affirming and inclusive forms;
• Using gender-affirming electronic medical records;
• Making sure staff and clinicians are well-trained in how to provide gender-affirming care;
• Providing gender-affirming hormone therapy;
• Using trauma informed care;
• Being aware of all the other things that involve gender affirmation for clients; and
• Creating programs and interventions informed by the lived experienced of transgender and gender-diverse people. We do this by collaborating with the transgender and gender-diverse community in amplifying their voices to meet their health and social needs.

DAP Health works to create safe spaces for transgender people across the organization. Two simple ways they do that is by putting employees' pronouns in email signatures and on name tags.

"It's a simple but very important element of creating safe spaces for people of all sexes and gender identities in a very respectful manner," says Velasco.

Taking the time to use a person's preferred pronoun doesn't have to be just in a health care setting.

"In our daily language we use pronouns," Velasco says. "We have conversations with everybody. And if we don't respect and honor the names or pronouns they use, it's a way of disrespecting them."

Five minutes with Dr. Tulika Singh

By Robert Hopwood

Dr. Tulika Singh is the director of research at DAP Health. She is a board-certified HIV specialist, infectious disease and internal medicine physician who has been working in HIV care since 2009.

Singh was born in India, where she went to medical school. She moved to the United States to enhance her education and completed her residency in Ohio. Her sister moved to Canada, but her mother still lives in India.

Before joining DAP Health, Singh completed an infectious disease fellowship in Wisconsin. She then worked at a couple of Michigan hospitals as a primary care, infectious disease specialist and an HIV specialist.

Since moving to California, Singh has settled into the Palm Springs lifestyle and has made the desert her home. People may be surprised to learn that Singh found her home on HGTV’s “House Hunters” show after moving to the Coachella Valley.

Learn more about one of the members of DAP Health’s care team.

Question: How did you get into HIV research?

Answer: I love doing research. That’s my newest passion. During my infectious disease fellowship from 2009 to 2011, I was awarded a prestigious award for my research. I then waited until I could do HIV-related research here at DAP Health.

Q. What did you want to do when you were young?

I wanted to be a dermatologist. But I started to see people with infections get better with the right antimicrobials and go on to live healthy lives. That’s when my passion shifted toward infectious diseases.

Q: Yoga is an integral part of your life. When did you start practicing it?

A: I started doing yoga in India when I was a toddler. Every morning I would do yoga with my father and sister before going to school. I continue to practice it for flexibility, peace of mind and its overall health benefits.

Q: You travel a lot. Where are your favorite places to visit?

A: I love traveling. I go to Mexico a lot, almost every three to four months. I have a timeshare there too, in Cabo. I also like vacationing in Hawaii. In summer I visit my sister in Toronto.

Q: How do you maintain an active lifestyle while traveling?

A: I used to travel quite a bit before COVID-19 happened. I was staying at hotels sometimes where there were no gyms or swimming pools. But I continued my lifestyle. I did yoga in my hotel room in the morning or went hiking or completed a seven-minute quick workout on my phone. I got my exercise out of the way, took a shower and was ready to start my day.

Volunteers essential to fulfilling DAP Health's mission

By Robert Hopwood

Volunteers are needed more than ever as DAP Health and Revivals Stores continue to expand across the Coachella Valley to meet the needs of the community.

DAP Health's sexual wellness clinic moved into a new space on July 6, 2021, and expanded its ability to treat more patients. Meanwhile, the health center's new Behavioral Health Clinic is set to open in September.

In May, Revivals Stores headed down Highway 111 and opened a new location in Indio, expanding into the east valley for the first time.

The new store, which needs about 40 volunteers, is expected to increase the resale chain's revenue. The profits from all four stores is sent to DAP Health, which uses the money to provide healthcare and other services to more than 9,700 people.

"The income from the Revivals Stores is an essential component of DAP Health's budgeting," Naishtut says.

Volunteers across DAP Health enable the health center to fulfill its mission of treating everyone who needs it with compassion, regardless of their ability to pay. 

Approximately 400 volunteers work at DAP Health and Revivals Stores, says Marcie Lerner, volunteer coordinator for Revivals. How many are active depends on the activities. During events like the Steve Chase Humanitarian Awards or the Desert AIDS Walk, more volunteers are needed.

Where do these volunteers work? The answer is throughout DAP Health.

They staff both the welcome desk in the main building and at the health clinics. They work in finance and resource development. Volunteers work with community health and outreach; they assemble safer-sex kits; they help staff the food depot; and they do much more, says Larry Naishtut, volunteer services coordinator at DAP Health.

Volunteers also provide Reiki, sound baths, yoga, knitting classes and more, Lerner says.

Volunteers do about 80 percent of the staffing at Revivals Stores, Lerner says. 

They do all the processing, price items and work the cash registers, she says. They help stock the sales floor, sort donations and work in the dispatch office scheduling pickups and deliveries.

"At any given time, there may only be five staff members at the store on a shift and the rest would be volunteers," says Lerner.

Volunteers donate about 70,000 hours of their time each year to help DAP Health provide compassionate, integrated care, Naishtut says. So far this year, volunteers have only contributed about 33,000 hours.

Without them, DAP Health wouldn't offer or support as many services as they do, Naishtut says.

Revivals Stores about 175 active volunteers, says Lerner. Some of them have been there for 15,000 hours. They range from high school students to people in their late 80s. One volunteer is even in her 90s.

Lerner says the people who volunteer for DAP Health do it because they want to give back to the community. They feel it's important to help somebody. And they are passionate about the mission of DAP Health, and they want to contribute in some way.

"Not everybody can afford to write a check," says Lerner. "So a lot of people will volunteer their time, as opposed to just writing a check as a donor. "

DAP Health and Revivals need volunteers all year long, says Lerner. Many retirees have taken the summer off, and Revivals Stores needs more volunteers, she says.

"It's always a struggle to find enough volunteers," Lerner says.

Volunteer opportunities available right now include about 30 open positions at the Revivals Store in Indio.

In addition to other volunteer positions DAP Health has available, it's looking for a computer tutor and a Spanish-speaking person who can run a social support group (non-therapy).

For additional information or questions about volunteering at DAP Health or Revivals, please contact Larry Naishtut for information about volunteering at DAP Health at [email protected] and Marice Lerner at [email protected] for information about volunteering at Revivals Stores.

Meditate with Dr. G

By Robert Hopwood

If you want to clear your mind, get rid of stress and find a little inner peace, consider meditation.

It can be done anytime and is a great way to start the day or finish it. That’s because mindfulness helps bring balance to our hectic lives.

A healthy life includes meditation time, says Dr. Jill Gover “Dr. G,” a licensed clinical psychologist who leads DAP Health’s Behavioral Health department. Downtime and rest are as important as physical activity. They keep our lives in balance.

“Meditation is a way of calming the mind, and in our very fast paced, stressful world, it's important for us to have moments where we calmly settle down and ground ourselves and meditation is a marvelous way to do that,” she says.

Mindfulness also is good for our physical health.

Research suggests meditation can help reduce blood pressure, improve irritable bowel syndrome, anxiety, depression and insomnia, according to the National Center for Complementary and Integrative Health.

Here are five meditation tips from Dr. G:

• Start by meditating for short periods of time. Long meditations, like an hours-long meditation, would be way too difficult for a beginner.
• Be compassionate and non-judgmental with yourself. Don’t worry about the self-talk in your head. It’s noise. Empty your mind. Imagine your thoughts are like clouds and watch them drift away. Then return your mind to what you were focused on, like your breath.
• Find a comfortable place to sit when you meditate. It should be quiet and free of distractions.
• Don’t worry about sitting still. If you sit in one position for too long, it’ll make you uncomfortable and start to hurt. It’s OK to move around.
• Start with something simple, like your breath or a simple mantra. Sometimes it’s helpful to play tranquil music or use a taped guided meditation.