MAI funding through Ryan White supported NMAC’s HIV/AIDS Stigma Program in the mid-2000s. Rather than provide directives around stigma, NMAC convened a diverse cross-section of service providers—health clinics, community based organizations, and AIDS service organizations—to discuss stigma-related barriers to HIV care, particularly within communities of color. The program also served as a conduit for peer-to-peer technical assistance, providing agencies working on the frontlines of the HIV epidemic with historically marginalized populations, such as people of color and substance users, an opportunity to share their lessons learned and best practices in retaining these populations in care. As Johnson explained,
NMAC never positioned itself as the expert on stigma. We wanted to allow agencies to adapt the information that they learned at their own agency. In reality, most approaches are ‘one size doesn’t fit most,’ since many are developed to address a specific community. The moment you start telling people that your approach solves stigma, you’ll have someone saying, ‘No this didn’t work for me.’”
A Culturally Competent Future
Developing and disseminating culturally competent approaches to care will continue to be paramount in the Ryan White HIV/AIDS Program. Since its inception, the number of people in HIV/AIDS has increased, while HIV-related morbidity and mortality has dropped dramatically. Since the passage of the Ryan White CARE Act in 1990, AIDS mortality has decreased from a high of 50,000 deaths in 1995 to less than 20,000 today.51
The epidemic continues to impact those living on the margins of society, who traditionally have not had access to health care due to poverty, lack of education, fear of mainstream medical providers, and other socioeconomic determinants. Others avoid HIV testing and care due to internalized social stigmas around sexuality and HIV in general.
Providers who understand how to work with these underserved populations are essential to ensuring positive health outcomes for those infected, and mitigating the impact of the virus overall. This may be particularly important in regard to youth and young adults, who know little about the early wave of the AIDS crisis and are woefully ignorant about HIV in general.
Building the capacity of agencies to adopt SPNS models and other culturally competent approaches will require greater support and resources. “People in clinics and service communities are overwhelmed with their day-to-day responsibilities,” says Bradley-Springer. “They often are just keeping their noses above the water line.” Fortunately, HRSA has provided these agencies access to a wealth of tools to bolster their capacity to deliver culturally competent care including online resources and trainings, replicable culturally specific care models, technical assistance to improve service delivery, and a comprehensive care team approach to address all patient needs.
Strategies for delivering culturally competent care, like the people who deliver it, must continue to evolve in response to the epidemic and the needs of those living with HIV disease. Perhaps Johnson sums up the importance of cultural competent providers: “Providers work best when they have a respect for their patients. Cultural capacity should not be a sort of add on or stand alone; but inherent to your thinking and how you care for people.” And that’s just what the Ryan White HIV/AIDS Program does.