HIV and the Recession: Living Well in Tough Times
ADAP is not the only game in town when it comes to medication assistance. Eligible individuals can also get discounted or even free drugs from the companies that make them. Most pharmaceutical companies offer patient assistance programs for their antiretroviral drugs. (See table below.)
Pharmaceutical company programs often have very stringent requirements for income and documentation. Be sure to pay special attention to them and ask for help from company program representatives to be sure you have everything in order. In some cases, your doctor will have to obtain drugs on your behalf.
Depending on your income, you may be eligible to receive antiretroviral medications at low or no cost through pharmaceutical companies' patient assistance programs (PAPs), or you may qualify for assistance with pharmacy co-pays for certain anti-HIV drugs. Call the numbers or check the websites below for more information.
Some clinics, like Fenway Health, receive government grants and private donations that allow them to offer low-cost or free services, whether the client has health insurance or not.
Make things easy on yourself: Look for a group that offers many services together. For instance, the San Francisco AIDS Foundation offers financial benefits counseling, a rent subsidy program, and support groups such as Black Brothers Esteem and El Grupo. In New York City, Gay Men's Health Crisis offers support services for men and women, and offers a free food program as well as yoga and massage. Agencies in many other cities, including HELP/PSI, AIDS Project Los Angeles, the Howard Brown Health Center in Chicago, and the Whitman-Walker Clinic in Washington, DC, also offer multiple services.
The advantage of connecting with one of these agencies is that you can talk to a single person who can direct you to several different services, rather than wading through the paperwork of each program individually. And the fewer places you have to shuttle between, the more likely you are to keep your appointments and get the help you need.
According to Michelle Latimer, a psychiatric nurse practitioner at HELP/PSI in the Bronx, up to three out of every four people with HIV also experience depression, anxiety, or other mental health issues. And that number is likely to go up as the economy falters, Fenway's Boswell predicted.
"HIV positive people are a mirror image of the larger community," he said. "Substance abuse is an issue among the larger community, and so it is with people with HIV. And when people are under huge stress, as we are whenever there's a financial downturn, there's an increase in use of substances. The same goes for insomnia and depression."
Depression and anxiety have been found repeatedly to be barriers to continued antiretroviral treatment adherence for a wide demographic range of people living with HIV. The good news is that help is available, even if you have little money.
Start With Your Doc
"A lot of people may not think to speak to their primary care provider for therapy," said Latimer. But often, doctors can offer referrals to therapists and other mental health care providers, and if you let them know your income limits, they may be able to help you find someone you can afford. In addition, primary care providers can prescribe medications to treat anxiety or depression.
Schools are another place to seek lower-cost mental health services. Look for colleges or professional schools that train marriage and family therapists, psychologists, and counselors, Latimer suggested.
"There, you'll find new therapists getting their Doctorate or Master's degree looking to get their final clinical hours," she said. "It's low cost or no cost, and you get a very enthusiastic provider."
You can contact schools directly and ask them if they have PhD candidates who might be looking for clients. As with other services, good timing can help you find the right therapist. In the fall, student therapists are often seeking clients and offering low or reduced rates, added Latimer.
You do not have to rely only on professionals to help lift yourself out of depression and prioritize your health. Family, friends, coworkers, and others can play an equally important role. In fact, a 2006 study reported in the journal AIDS Care found that choosing a support partner to help maintain adherence to medication regimens and cope with HIV disease significantly helped participants stay well.
"You have to look once again to those things that money can't buy -- for example, healthful relationships with other people," said Phil Johnson, Ed.D., Adjunct Professor of Health Education at Teachers College, Columbia University, in New York City. "If you have that one friend whose shoulder you cry on, and for whatever reason when you're done talking you feel better -- those are the people to maintain relationships with."
It may seem counterintuitive: When you're in need and hurting, you may feel like you have nothing to give. But research has repeatedly shown that the more people help others, the better they feel about themselves, and the more optimistic they are in general.
Johnson recommends looking into peer education and support programs, which are usually free. There, you can meet people who've dealt with the same problems you are facing. And then you can turn around and help other people who are currently struggling.
"Imagine how useful you can be [to] others like yourself," Johnson said. "They have the same thought processes you did. You're there to help them through [a difficult] time and provide a very meaningful service."
Or, as HELP/PSI's Reyes put it: Don't just look for help; provide it. "The best help usually seems to come from those who have suffered the most, because they can recognize the quickest, best way to get you out of it," she said, recalling a time when neighbors discreetly helped her family hide from their landlord when the rent was due. "If you can hook up with someone who needs you -- or if you can hook up with someone like that yourself -- you can find help, even if you are broke."
This article was provided by San Francisco AIDS Foundation. It is a part of the publication Bulletin of Experimental Treatments for AIDS. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.
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