After months of engaging stakeholders, including social workers, to develop a national strategy, the Obama administration in July announced its strategic plan to effect a 25 percent reduction in the annual number of new HIV infections in the U.S. by the year 2015.
Right now, an estimated 56,300 Americans are infected each year with HIV, the virus that causes AIDS. To lower that number to 42,225 in the next five years, the White House wants to reallocate funding and refocus prevention efforts toward those at highest risk of being infected — namely minorities, substance abusers and men who have sex with men.
“Not every person or group has an equal chance of becoming infected with HIV,” notes the strategic document, developed by the White House’s Office of National AIDS Policy. “Yet, for many years, too much of our nation’s response has been conducted as though everyone is equally at risk for HIV infection.”
Arriving at that number of 42,225 will require reducing the HIV transmission rate by 30 percent and increasing to 90 percent the proportion of people living with HIV who know their status, the document says. Currently, one in five HIV-positive Americans don’t know they are infected.
The strategy also calls for increasing access to and improving care for people living with HIV.
“Despite our significant public investments in health care services through Medicaid, Medicare, and the Ryan White HIV/AIDS Program, too many people living with HIV do not have access to the medical care that they need,” the document says.
Recommendations include facilitating linkages to care, promoting collaboration among providers and increasing the number and diversity of HIV care providers.
The recently enacted Affordable Care Act goes a long way to expanding insurance coverage for people living with HIV, the Obama administration notes. The law provides for the creation of high-risk insurance pools in every state so that people with chronic conditions, such as HIV/AIDS, who were previously uninsurable can obtain coverage. It also eventually expands Medicaid eligibility and provides for tax credits to help more Americans afford insurance.
The administration also aims to cut HIV-related health disparities by ensuring that high-risk communities have access to medical tests that track the amount of HIV copies and number of T cells in one’s blood; adopting community-level approaches to reducing HIV infection; and reducing stigma and discrimination against people with HIV.
“The president’s strategy validates what social workers have recognized from the beginning — that improving care and access to that care for people living with HIV requires a more coordinated and comprehensive approach,” said Evelyn Tomaszewski, NASW senior policy associate.
Tomaszewski staffs the association’s HIV/AIDS Spectrum Project, which trains care providers on the mental health aspects of living with HIV/AIDS. She said that people living with HIV need access to services beyond just testing to know their viral load and T-cell count.
“HIV often is accompanied with a host of co-morbidities and sequelae — such as depression, anxiety and substance abuse — and we need to move beyond the medical model of treatment,” she said.
Last June, at an Institute of Medicine workshop for the White House’s Office of National AIDS Policy, Tomaszewski advocated for a holistic approach to HIV prevention, care and treatment, noting that a third of people living with HIV require mental health services.
Tomaszewski also stressed the importance of culturally competent care.
“I highlighted best practices that show that successful treatment begins with what social workers call ‘starting where the client is at,’” she said. “Truly client- or patient-centered care takes into consideration the person’s cultural perspective — individualist versus collectivist orientation — and their understanding of the origins of disease.”
She continued: “Understanding cultural context helps social workers to build relationships that respect history while providing facts and resources for HIV and other chronic illnesses.”
Though the strategic plan gives credence to moving beyond the medical model of care, Tomaszewski thinks social workers will prove to be even more instrumental in meeting the president’s targets in 2015. She urges social workers who either directly receive federal funding, through the Centers for Disease Control and Prevention or the Substance Abuse & Mental Health Services Administration for example, or work for an agency that does to review the strategic plan and accompanying federal implementation plan to determine ways they can contribute toward achieving the goals.
Get more information on NASW’s HIV/AIDS Spectrum Practice section.