June 5, 2012
The 10th in a series of articles about the Road to AIDS 2012, a 17-city tour that seeks to define the state of the U.S. epidemic and that leads up to the International AIDS Conference in Washington, D.C., in July 2012. The ninth installment reported on the Las Vegas meeting.
While the National HIV/AIDS Strategy (NHAS) and Affordable Care Act (ACA) will help many people with HIV gain greater access to better-quality care, participants at a Denver town hall meeting voiced concerns that many local residents will fall through the cracks.
An audience made up primarily of federal-government employees from such agencies as the U.S. Department of Health and Human Services and Department of Labor listened at Mi Casa Resource Center in Denver on May 7 as HIV/AIDS-community leaders described the challenges that Denver faces in fighting the HIV/AIDS epidemic.
One of the biggest concerns was that foreign-born residents who are not U.S. citizens will lose care because they will not be covered under the ACA, said panelist Maria Lopez, program manager at the Denver HIV Resources Planning Council (DHRPC).
Panelist Joshua Blum, M.D., a physician who also sits on the DHRPC, agreed, saying that approximately 20 percent of his patients are foreign-born.
Another concern was that the NHAS could work too well. If the strategy is successful, more people who currently have HIV/AIDS will be identified and given access to high-quality care. However, "if there are a lot more people identified as HIV positive, it can be a strain on our resources all across the country," said Dr. Blum. Even though many community-based organizations are dealing with budget cuts and decreases in funding, "we need to be ready to increase resources to deal with this," he added.
Though the ACA is designed to reduce barriers to coverage, it may inadvertently keep some people from getting the very coverage they need, participants said. Programs such as the AIDS Drug Assistance Program (pdf) were set up to provide medical treatment to those without health insurance. But with health-care reform giving more people access to care, some of these initiatives may fall away. Panelists also expressed concerns that safety-net hospitals that provide care to people who are uninsured and underinsured may lose resources and be unable to help as many people. For example, "my hospital could start losing dollars to other hospitals, so we may not have money for people with no insurance," Blum said.
Panelist Penny DeNoble, founder of the Issue of Blood, an HIV/AIDS outreach organization located in Denver that focuses on Black women and girls, described how marginalized communities continue to be denied access to care and the latest research. She expressed her desire that the NHAS do a better job of getting information about scientific breakthroughs to the community.
Apathy about the impact of HIV/AIDS was another concern brought up by the panel. With fewer people dying from HIV than in the early years of the epidemic, there isn't the sense of urgency among members of the community, town hall participants said.
Other panelists at the event included Robert George, regional director for the Colorado AIDS Project, and Francisco Ruiz, senior manager for racial and ethnic health disparities at the National Alliance of State & Territorial AIDS Directors.
Most town hall participants agreed that there will probably be some growing pains when the ACA is implemented. For that reason, even as health-care reform is rolled out in its entirety in 2014, it's important that the community take the opportunity to advocate for the continuing role of programs such as the Ryan White HIV/AIDS Program in supporting people living with HIV.
It's also crucial that those who provide care for people with HIV/AIDS anticipate problems that will arise from all of the changes to the health-care system, participants said. "We're looking at being able to insure more people, so access to care should improve," one audience participant said. But it will take time, he warned. "It's not going to transform the health-care delivery system overnight."
The entire Road to AIDS 2012 tour is a joint effort between the Washington, D.C.-based Community Education Group, the Urban Coalition for HIV/AIDS Prevention Services, pharmaceutical company Merck and AIDS 2012. The Road to AIDS 2012 will seek community input in cities across the country. That input will be shared at AIDS 2012 in Washington, D.C., when the International AIDS Conference is on American soil for the first time in more than 20 years.
Tamara E. Holmes is a Washington, D.C.-based journalist who writes frequently about health and wellness.