The Next Wave in AIDS Care: Reauthorization of the Ryan White CARE Act 2005-2010

Based on these factors, it is clear that programs serving uninsured or underinsured people living with HIV/AIDS should adhere to the following principles:

• Reduce disease-related stigma. There is no quick solution to the problem of AIDS-related stigma. Change must happen, but it is simply pragmatic to expect it to be slow and difficult in coming. What can make it easier is for HIV patients to have some peace of mind in knowing that they their needs for care are going to be met; security that comes from knowing they will not have to quit their jobs; serenity in truly believing that they can stay healthy enough to continue to care for their families and remain in the workforce. Living with a deadly disease to which stigma is attached is enough of an obscenity without also having to deal with the day to day stresses of worrying about maintaining access to care and treatment.

• Reduce confounding social factors for people living with HIV/AIDS such as racism, homophobia, and sexism. By standardizing HIV testing and counseling in mainstream medical care, establishing and continuing prevention programs that address AIDS at its root causes, and being open to discussing the role sexuality plays in the spread of the epidemic, we can eliminate racism, homophobia, sexism, and AIDS itself. The reality continues to be that any person from any corner of this country is susceptible to HIV infection.
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• Reduce other socioeconomic and medical confounders such as poverty and homelessness, as well as medical conditions related to mental health, history of substance abuse, hepatitis, tuberculosis, and sexually transmitted diseases.

• Build personal dignity into Quality Management and Continuous Quality Improvement.

• Empower people living with HIV/AIDS to make choices based on objectively assessed needs as this will benefit their medical and social outcomes without creating a dependency system. The HIV/AIDS care system should focus on helping people lead normal, productive lives instead of making them feel that their lives are solely about dealing with a disease. Care and services should be available for people who want to work and be independent if that is what they choose.

• Provide philosophical guidance to service provision systems/personnel to focus on preventing disability rather than encouraging physical and mental disability.

• Allow recipients to return to work without losing their healthcare benefits. PLWAs should not have to choose between healthcare and dignity of work. HIV/AIDS stigma is fueled by antiquated public policy. It puts put people living with HIV/AIDS in fear of losing access to the very care that restored their health when they muster the courage to return to the workforce. It is becoming a reality that you can live healthy with HIV and work. Government and industry need to realize the benefits of allowing HIV-positive people to work and seriously consider the economic consequences of so many PLWAs being pulled from the workforce due to this disease.

• Provide for meaningful input into healthcare planning by people living with HIV/AIDS. Involving people living with HIV/AIDS in the planning process empowers the clients but also affords providers the unique opportunity to learn first-hand what works within the system, as well as what needs improvement and how it can be improved. Without PLWAs, program design may suffer set backs and breed resentment among the very communities the programs are designed to serve.