Views From the Front Lines: STOP HIV/AIDS
The STOP HIV/AIDS pilot project has been running since 2009/2010. Looking back at the past two years, what would you say are some of the key lessons learned?
One of the key lessons learned by STOP participants in Prince George is the need to work more collaboratively in our service delivery approach Although we had already been working quite well together beforehand, we've learned to work more collaboratively, to provide services that are more integrated and better meet the needs of our clients. When we find a gap in our services, we now ask, "How can we work together to fill it, using not solely a medical model and not solely a social model but a combination of the two?"
Initially, we were all speaking different languages. Trying to find common ground was difficult but we worked through that. We're collaborating and figuring out ways to discuss these issues because they're all intertwined and we have clients who access all of our services. We can't solve the issues in isolation -- our agencies need to use a coordinated approach.
To your knowledge, what has the impact of STOP been on services for people living with and at risk for HIV? Has it changed or improved the patient experience?
Something unique that we identified within Northern Health is the need for a pharmacist who specializes in HIV. The development of that position has allowed many clients to discuss with the pharmacist their treatment options and talk about side effects: Having that one-on-one contact is very beneficial because clients often don't know what to ask of their doctor. I think that having the pharmacist here is one of the biggest benefits.
Also, there is now a storage of anti-HIV medications here at the Prince George Regional Hospital. Before, when somebody was on treatment there was often a stretch when people didn't have meds. That has now been dealt with -- we now have medications to tie people over until their medications arrive from Vancouver.
We've also identified the value of doing patient journey mapping [a process used to map patients' experiences with the healthcare system and identify areas for improvement]. During open, non-judgemental group discussions, patients who did the journey mapping commented on everything from "this has been my experience with the hospital" to "these are some of the barriers I'm facing on an everyday basis." Participants had the opportunity to talk about their lived experiences and provide feedback to policymakers on how services could be improved. That experience let them know that not only are people listening but there might be an opportunity for change.
Sometimes, we as service providers feel we know what's best for clients but often what we identify as clients' needs aren't what the clients actually want.
One of the goals of STOP has been to test and treat groups in Vancouver and Prince George who have been disproportionately affected by the epidemic and groups who face multiple barriers to accessing information and care -- including gay men and other men who have sex with men (MSM), people with addiction, housing and mental health issues, among others. How successful do you think the project has been at reaching these populations?
I think that before STOP began, we had some success in accessing those populations, particularly Aboriginal people and people who use injection drugs. But we haven't built a very tangible connection to the MSM communities. Positive Living North and other organizations do participate in Pride and the university's gay/straight alliances but it's been difficult to access that target population.
When it comes to testing, anybody in Prince George can go to their doctor, health unit, needle exchange or regular clinics ... so testing is now available but for those in outlying communities, outreach is more problematic. This is something I've said right from the beginning: STOP shouldn't have been piloted in Prince George. We are already quite well resourced. What we really need to look at are those smaller communities where there's a lack of resources, with populations of 15,000 or less. That's where the greatest gaps are. Northern Health is looking at how the testing strategy can be filtered out throughout the entire Northern Health area. What would point-of-care testing look like in smaller communities, like Smithers or Fort St. John?
One of the things that the Northern Aboriginal Task Force looked at is community readiness and community need. There are 65 First Nations in the North. There is definitely a lack of information and a lack of training among First Nations to do HIV care and harm reduction work. Some First Nations are still resistant. There have been efforts to educate some of those smaller communities and reinforce that by doing harm reduction, you're not supporting drug use but you're supporting safe usage among your clients. Regardless of whether the materials are there or not, people will use drugs.
Although STOP is focused on maximizing the number of people who get tested and the number of people with HIV on treatment to lower their risk of transmitting HIV, we are not doing that at the expense of public education. Northern Health still supports agencies such as Positive Living North to ensure that we can continue to go out and provide education to these target populations. You need to reduce the risk of transmission from target populations but you also want the general public to be aware of their risk.
STOP has captured media attention nationally and internationally, and it has sparked controversy. While the strategy has been hailed as groundbreaking, some have also expressed concern that it may threaten people's privacy and autonomy. How do you respond to these concerns?
Right from the start, Positive Living North had concerns regarding a very medical model that was focused on the people accessing treatment in support of less transmission to others. It's not simply about medication and adherence, it's also about supporting the individual. As others have said, it shouldn't be just "seek and treat," it should be "seek, support and treat." That way, the individual's needs are met too. Knowing that there's a wide array of barriers that clients face, support is as important as the medical components.
We haven't really heard our clients raise concerns about privacy and autonomy. When people are looking for a place to live or they're looking for food or they're dealing with addiction issues, that's not their priority.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication Prevention in Focus: Spotlight on Programming and Research. Visit CATIE's Web site to find out more about their activities, publications and services.
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