Philadelphia Talks About Community Coordination with the National HIV/AIDS Strategy

By jschneidewind on November 17, 2011 in National HIV/AIDS Strategy

by Carole S. Treston, Executive Director, AIDS Alliance for Children, Youth & Families

On October 20, the White House Office of National AIDS Policy convened the third in a series of public forums to address the implementation of the National HIV/AIDS Strategy (NHAS) and the Affordable Care Act (ACA). This session, “Sustaining the Community-Based Response to HIV” held in Philadelphia, was attended by community based providers, local government, medical providers, consumers and activists and academics from the Philadelphia region. The panel – local and national experts, talked about their perspectives on the expansion of Medicaid and other changes in the HIV funding and service delivery environment provided by the ACA and how that may support or possibly hinder achieving the goals of the NHAS.

One of the main goals of the NHAS is to reduce new infections by 25% and an audience member asked how we could achieve this, since new infections have remained at the same rate, more than 50,000/year- every year for a decade now. Did the Centers for Disease Control and Prevention (CDC) intend to fund differently or change its priorities? I’m not sure that was fully answered to the audience’s satisfaction, but Paul Kawata spoke about how the recent scientific data of 052 and the PreP studies support treatment as prevention. He pointed out that this and other advances show the potential for ending the AIDS epidemic in the US. It is possible. We have the knowledge, but do we have the political will (and resources) to achieve that vision? He reminded us that people living with HIV/AIDS (PLWHA) began this struggle and must continue to lead the efforts to the conclusion.  The expansion of Medicaid in 2014, theoretically will increase access to medications and treatment, but there remains a lot of concern in the community about diagnosis and treatment and that we still have a long way to go to educate people about the benefits of knowing their HIV status and getting into treatment. We know the role of Community Based Organizations (CBOs) and PLWHA is the front line there.

This hit home later that week. Philly is my hometown, my family is there and I still live there. That weekend, my niece told me one of her friends just tested positive. He’s a twenty two year old black gay man who lives at home with his mother and sister in North Philadelphia. With the support of his mother (she didn’t throw him out of the house, as unfortunately is too often the case) he is beginning to deal with his diagnosis, get into care and remarkably – tell his friends. But the two guys and one girl who also slept with the same guy, don’t want to know their status, don’t want to talk about it and will not get tested. We still have a way to go.

With the ACA, many patients (but not all) who were formerly uninsured and cared for through Ryan White dollars will now be eligible for Medicaid. Due to this expansion in a shrinking budget environment at the state and federal levels, the likelihood of shifts in Ryan White resources looms in 2013 and beyond. With the possible loss of Ryan White funding, CBOs that deliver only HIV services and/or rely solely or largely on Ryan White funding could be in jeopardy.  Also, the focus and investment in Community Health Centers, in particular Federally Qualified Health Centers (FQHCs) is likely to be an ongoing trend in health care delivery through this decade. FQHCs must provide a continuum of care, not specific to one population or one disease, regardless of a patient’s ability to pay.

The message was clear – organizations need to be preparing for the future NOW.  Two organizations that made the shift were featured, The Mazzonni Center (Phila) and Whitman Walker Health (DC).  Nurit Shein, Executive Director of the Mazzoni Center, and Don Blanchon, Executive Director of Whitman-Walker Health, both talked about expanding their mission beyond HIV to healthcare for the larger LGBT community, adopting a new business model, and working towards FQHC status. Both are continuing to take a hard look at what their population needs, identifying what their organization has done well, determining what was better done through collaborative formal partnerships with another agency, and, in some cases, deciding which activities and services they needed to divest because other organizations were doing them better.

The role of incarceration in fueling the HIV epidemic and health disparities kept coming up and the audience was not going to let their concerns go unanswered- this is the home of ACT-UP Philadelphia after all. Currently, when someone becomes incarcerated, they are terminated from Medicaid and they face an uphill battle to regain coverage after release, which presents a big problem for getting and keeping PLWHA in stable medical care post-release without Ryan White programs. The link between disproportionate rates of incarceration in black men and the disproportion rate of HIV and health disparities was well made by audience members. While the provision of care through community health centers to individuals when they are released from prisons, regardless of their insurance status or ability to pay was well described by Kathy McNamara from the National Association of Community Health Centers, the vital role that Ryan White resources play in linking and retaining PLWHA in care post- release.  No matter how different the future will be, there will still be a need for the Ryan White program — still as a safety net, but now for the ACA, if we are to achieve the goals of the NHAS and end the AIDS epidemic in the US in our lifetime. Wouldn’t that be something?

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