February 6, 2007
New York City -- The New York Academy of Medicine's newly published free training manual, "Breaking Barriers: A Toolkit for Getting and Keeping People in HIV Care," provides health professionals with effective strategies to help people of color and other vulnerable populations receive sustained HIV/AIDS care. People of color, primarily African Americans and Hispanics, constitute 58 percent of cumulative U.S. AIDS cases since the epidemic began in 1981, and many have weak or nonexistent connections with the healthcare system. They are unable to access treatment and services due to formidable barriers such as homelessness, substance abuse, or lack of knowledge about navigating the medical system.
The manual of strategies is based on the Academy's seven-year evaluation of 23 HIV/AIDS service agencies throughout New York City and Westchester. These programs serve 3,500 HIV-positive or at- risk clients annually and are funded by the Congressional Minority AIDS Initiative, established by the federal government in 1998 to address the disproportionate HIV/AIDS crisis in minority communities. Over the past seven years, the Academy's Division of Health Policy has been evaluating the challenges and successes experienced by these local programs in helping people who fall through the cracks, with funding from the federal government that is administered by the New York City Department of Health and Mental Hygiene.
"We hope the manual will be of service to people looking for ideas on how to reach and connect vulnerable populations to medical care," said Elana Behar, co-editor of the manual and a Research Associate in the Division of Health Policy. "While designed for healthcare providers seeking to alleviate the disproportionate HIV/AIDS burden in ethnic minority communities, the manual can be useful for healthcare professionals looking to connect all sorts of populations to the care system."
When recruiting clients who are not receiving medical treatment, the manual advises, the first steps of outreach involve learning about the routines and customs of the population, and making visits to areas in a community that these potential patients are likely to frequent, such as soup kitchens and outpatient drug treatment facilities. Once the outreach zone is established, it is important to make and strengthen connections with potential clients. Outreach workers should try to establish a presence in the area, build relationships with the population, provide health education, and inform the potential clients about the services provided by the agency Once clients have been recruited, the manual explains, healthcare barriers must be addressed and removed by providing clients with health education, helping them to find stabilized housing, helping them to apply for health insurance benefits such as Medicaid, and other actions consistent with patients' needs. The "Breaking Barriers" manual explains how to accomplish those goals and strengthen a client's access to medical care once a connection is established. Each patient must receive an individualized plan as well as referrals to other agencies that provide needed services, the manual emphasizes.
The approaches described in "Breaking Barriers" are based on years of successfully helping clients in the HIV/AIDS service agencies, known as Access-to-Care (ATC) and Maintenance-in-Care (MIC) programs. ATC and MIC programs help clients achieve important health goals, such as reducing drug use, initiating HIV medical care, and adhering to anti-retroviral medication regimens, Behar said.
In addition to serving as a valuable tool for healthcare providers eager to recruit and engage HIV-positive and high-risk clients, the Academy manual provides information on how to establish a program similar to ATC and MIC programs. It explains the importance of developing a thorough understanding of the program's target population, identifying requirements of the funder, addressing related legal issues before forming the program, and then hiring qualified staff and establishing links to related programs.
The manual, co-edited by John Chin, PhD, Senior Research Associate at the Academy, can be downloaded free of charge on the Academy's website at www.nyam.org/library/docs/BreakingBarriers.pdf.