for Cynthia Gomez, director of the Health Equity Institute for Research, Practice and Policy at SF State
With a $2 million grant from the National AIDS Fund, you and your team just launched the Bay Area Network for Positive Health, a collaborative effort to improve access to HIV care in San Francisco and the East Bay. What do you hope it will accomplish?
San Francisco boasts state-of-the-art HIV care, and Oakland has been on the advocacy forefront, but still there are 8,000 people in the Bay Area who know they have HIV but aren't engaged in care. We want to link these underserved individuals to essential HIV care and to better understand why they weren't in care to begin with.
You've researched HIV prevention and care for decades. How has the issue of connecting people with HIV to care changed over the years?
When HIV first emerged, people were dying and we weren't looking at the nuances of who was in care and who was out of care. Largely this was because the treatments we had to offer weren't very effective, and often people didn't take medications because the side effects were worse than treatment. That all changed in 1997, when we had our first effective medications. Suddenly, the people living with the disease increased exponentially. We started to see very similar patterns as you do with any chronic disease, which is that a lot of folks aren't in optimal care.
What are some of the barriers to care and treatment?
People may have trouble accepting their diagnosis or they don't seek care because they aren't comfortable being viewed as ill when they have no symptoms yet. For those who are homeless, substance users or recently released from prison, the systems of care are often difficult to navigate.
How do the goals of the new collaboration mesh with the goals of SF State's Health Equity Institute, which you direct?
The folks we're looking to reach with this new effort are the most disenfranchised, the most marginalized populations. The institute's goal is to create equal opportunities for health for all, so this project really fits with our mission.
How will your collaboration with multiple agencies on both sides of the Bay improve community health as a whole?
If we're successful in reducing the number of people out of care, and those people are treated and retained in care and that treatment is successful in reducing viral load, then essentially we're reducing the ability to transmit HIV. That improves the health of the whole community.
What is community viral load and what's its significance in the fight against HIV?
When we look at people's HIV status, we look at viral load -- how much virus is in their system. Community viral load does the same thing for neighborhoods. The San Francisco Health Department can create maps to show where the concentrations of viral load are highest and this tells us where people are not receiving optimal treatment.
What competing priorities do people in these underserved communities face when dealing with HIV care, and how will the consortium address this?
We do recognize that for some folks, HIV care is too far down the list of priorities. They may need housing, employment or drug treatment. We're going to ask everyone about their priorities and connect them with the appropriate social service agencies. There may be intermediate concerns to deal with before we can link them to HIV care.
What is unique about the consortium's approach to getting people connected with treatment for HIV?
We're engaging organizations that are not typically involved in HIV care but work closely with disenfranchised populations. There's a Street Level Health Project in Fruitvale, for instance, that provides services to indigent immigrant populations. They offer weekly general health checkups. If they can find people who are not in HIV care and link them with services, we think it will help.
What makes the network equipped to tackle this long-standing problem?
We tried to create a network where each agency brings something different to the table. One group has experience with youth. We have a group that's working specifically with the African American community. We have folks specifically focused on women. We think this makes us stronger as a whole, without every agency having to be an expert in all areas.
How will you measure the success of this three-year program?
Our success will be measured by the number of individuals we link into HIV care, and by our ability to reduce barriers to accessing care. In the long term, we should also see a reduction in new HIV infections and in overall community viral load in the Bay Area.
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