July 12, 2012
The 14th 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 13th installment reported on the Atlanta meeting.
The transition to the Affordable Care Act (ACA) and the impact of the National HIV/AIDS Strategy (NHAS) on community-based organizations (CBOs) dominated the conversation at a town hall meeting at the Center for Community Cooperation in Dallas.
More than 30 community participants -- many of whom work for CBOs -- took part in a discussion about the greatest challenges affecting the Dallas area when it comes to managing the HIV/AIDS epidemic.
"We have a lot of preparation to do," said panelist Ann Robbins, manager of the HIV/STD Prevention and Care Branch at the Texas Department of State Health Services. "We need to make sure we're talking and moving forward."
One change that CBOs face relates to how PLWHA receive their care. In the past, methods of HIV/AIDS prevention and treatment have been separated from those of other medical illnesses. However, the ACA and NHAS propose integrating HIV prevention and treatment with other health-care issues and having traditional health-care providers, for example, become the focal point for HIV prevention and treatment. Much of the funding designated for HIV/AIDS will go toward organizations that provide clinical care.
However, that raises questions about what role traditional CBOs and AIDS service organizations will play in the future. To prepare for the changes, CBOs must start looking for new ways to generate income, town hall participants said. For example, some of the work performed may be billable. "You must look at what you're good at and see who pays for that," said Robbins.
But some of the tasks that organizations take on, such as transporting HIV patients who can't get a ride to their doctor, may not be billable. "Community-based organizations are going to have to look at a business model that will keep them afloat," said panelist Zach Thompson, director of Dallas County Health and Human Services.
Community organizations might build partnerships with other CBOs and health-care organizations that don't have an HIV focus, and CBOs that don't provide clinical services must form collaborations with organizations that do. They must also do a better job of communicating the value of their services, town hall participants said.
Organizations will also have to start thinking about expanding services. Whereas in the past an organization might have counseled people only on HIV/AIDS, it may now start providing information on other health challenges, such as diabetes and high blood pressure. "In shaping new models, we must figure out what our lane is and expand it," said event moderator A. Toni Young, executive director of the Community Education Group.
Not only do organizations need to prepare themselves for the looming changes, but they also bear the brunt of preparing the general community for the changes that will result when the ACA is fully implemented in 2014. Now that the Supreme Court has upheld the ACA, more people will have access to insurance, whether through private insurers or Medicaid. "Does the community know about these changes? Because having insurance is different from showing up at a clinic to get a service," said Robbins.
Other panelists at the town hall included Dena Gray, HIV-prevention program manager for the Houston Department of Health and Human Services; and Regina Waits,the HIV/AIDS regional resource coordinator for Region 6 of the U.S. Department of Health and Human Services.
While the overriding concern among town hall participants was how CBOs can stay alive, some participants feared that people living with HIV will be the biggest losers in the transition. "Clients will see a decrease in services if we don't do this right," said Thompson.
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 emotional health and wellness.