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Clearing a Path
The single-most critical achievement
of the CARE Act is that it facilitates access to care for
people who have historically had very little. The results
of this achievement are reflected in the demographics of
CARE Act clients.
In 2004
- 59 percent of all CARE Act clients were racial minorities12
- 23 percent were ethnic minorities12
- 50 percent lived at or below the
Federal poverty line
- a mere 11 percent had any private
health insurance.13
The fact that CARE Act-funded providers
are able to reach people in these circumstances represents
an enormous victory in the fight to reduce health disparities
among minorities and the underserved. This victory is occurring
because of the funding and support that the CARE Act gives
communities striving to reach people that the larger medical
system has failed to reach. It is occurring because of Health
Resources and Services Administration (HRSA) programs like
Health Disparities Collaboratives (www.healthdisparities.net/hdc/html/home.aspx),
which offer hands-on, disparity-reducing tools for clinical
care providers. And it is occurring because providers all
over America share HRSA’s commitment to fight for access
for people who don’t have it.
After postponing their visits for
as long as symptoms allow, many people without private health
insurance in the United States go to hospital emergency rooms
for acute care. They go seeking treatment for what started
as minor infections that could easily have been addressed
in a primary care setting. They go suffering from serious
diseases they don’t know that they have. And most who
go, do so because they have no other choice. It doesn’t
have to be this way.
CARE Act-funded providers have shown
that we can clear a path toward better health for the underserved.
How? By acquiring cultural and clinical skills to address
HIV/AIDS. By addressing comorbidities of HIV/AIDS such as
hepatitis C and mental illness. By providing access to specialty
care like gynecology, oncology, rheumatology, and cardiology.
And by recognizing that, for some people living with HIV/AIDS,
providing clinical care and treatment alone isn’t enough.
And Then Clearing a Path Again
At the root of inequities in health
outcomes lies a shortage of health care services in underserved
communities and a shortage of services that are affordable
to poor and inadequately insured people. There lies stigma
and fear. There also lies undiagnosed HIV infections and lack
of awareness that services are available. Community-based
collaboration provides a framework for clearing a path through
interrelated problems like these and it is why the most successful
CARE Act-funded providers almost never work alone.
The CARE Act Amendments of 2000 call
for providers to collaborate with “key points of entry”
into the medical system—organizations that have relationships
with people at high risk for HIV infection, or who are already
infected but unaware of their status or who, for some other
reason, are not receiving care and treatment. They work in
partnership with substance abuse treatment centers and emergency
rooms. They create referral relationships with health departments
and housing agencies. They go into communities, out into the
streets—and into prisons, too.
“Our team goes into correctional
settings,” explains Dr. Lawrence Crane, the medical
director at the Detroit Medical Center/Wayne State University
HIV clinic.
When they are released, many
become our patients here. In fact, our clinic is seeing
about 75 newly-paroled patients per year now. When I see
a patient at a prison who is about to be released, I give
him a business card. It’s one of the most important
things I do. That card is their lifeline, and I tell them,
‘Make sure the very first thing you do when you get
out of here is call the man whose name is on this card.
His name is Bernard.’
Bernard Mallisham is a counselor/advocate
in Detroit and an expert at linking people with medical
care, job training, and housing support—the kind of
services that are essential to rebuilding a life and staying
in care. There are other people like Mallisham in Detroit
and at CARE Act-funded sites all over America. They are
the people who make care possible.
And Again and Again
A visit to CARE Act-funded sites reveals
the scope of the epidemic among the poor and among minorities.
While the pathway to care has been cleared for these individuals,
it is still littered with enormous barriers for others. Hundreds
of thousands of people living with HIV/AIDS are not in care—many
because of disparities in access to health services. Unless
we continue to remove the barriers that create those disparities,
what will these people do? Where will they go?
  
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