We know us: Community-led models of HIV care

SY09

Symposium

Track E - Implementation science, economics, systems and synergies

CME accreditation

Plaza Terrace Room/Channel 2

25 July 10:30 - 11:30

Moderator

Judith D. AUERBACH
University of California San Francisco, United States

As we embark on this fifth decade of the HIV pandemic, especially amidst the COVID-19 pandemic, it has become abundantly clear that communities are the heart of a successful response. This session will describe lessons learnt in the implementation of community-led models, ranging from models that are leaning more towards the integration of non-communicable and mental health services as people living with HIV age to key population-led models to ensure that no one is truly left behind, especially with the introduction of novel prevention tools. The session will also include representation of young adults to describe best practices while tailoring models for adolescent-focused models of care. At the end of this session, the audience will be able to describe the key elements of a community-led model, as well as opportunities and challenges to their successful implementation.

Presentations
Rapporteur Summary

10:30 5 min	Introduction Judith D. AUERBACH University of California San Francisco, United States

10:35 10 min	Role of non-HIV entry points to improve uptake of HIV services in gender-minority populations in low- and middle-income settings Simran BHARUCHA India HIV/AIDS Alliance, India

10:45 10 min	Building a people who use drugs model of care: What I have learned from two decades of research Donald BROWN Johns Hopkins School of Medicine, United States

10:55 10 min	Models of care to improve access to health services among Indigenous populations James WARD University Of Queensland Poche Centre For Indigenous Health, Australia

11:05 25 min	Live Q&A James WARD University Of Queensland Poche Centre For Indigenous Health, Australia Simran BHARUCHA India HIV/AIDS Alliance, India Judith D. AUERBACH University of California San Francisco, United States Donald BROWN Johns Hopkins School of Medicine, United States

AUTHOR

Daniel Reeders

SUMMARY

An important session that explores the role that community engagement and the social determinants of health, both, play in the careful design of feasible and acceptable models of HIV care.

HIGHLIGHTS

Simran Bharucha (India) says non-HIV entry points – including gender affirming care, legal and social services – provide opportunities to enroll gender diverse people in prevention and HIV care. Over half her clinic’s clients previously lacked access to care. James Ward (Australia) reports most Indigenous people in Australia have reasonable access to sexual and reproductive health care, yet barriers and inequities remain, particularly in remote settings. Aboriginal Community Controlled Health Services care for half the Indigenous population and are acceptable to young Indigenous people for HIV and STI care. Ward believes that peer-led models such as peer navigation are promising; yet we need to consider how these approaches can be scaled-up and made sustainable. He argues we need to move beyond volunteer and casually-employed peers and instead employ members of affected communities in ongoing roles. Donald Brown (USA) is a peer outreach practitioner in Baltimore. Maintaining partnerships to reach marginalized communities requires ‘meeting them where they are’ — acceptance, dignity and respect are crucial. In order to address HIV, we first need to listen to the underlying and seemingly peripheral issues that concern communities, such as food insecurity and homelessness. ‘One-stop-shop’ service delivery requires collaboration with non-HIV social services.

CRITICAL ASSESSMENT

James Ward observes technologies like point-of-care testing can only benefit people with access to care. Research (e.g. Link & Phelan 1995) predicts disparities continually re-emerge despite intervention if we do not address their ‘fundamental causes’ — the dynamic social mechanisms that generate them in the first place. Donald Brown’s remarks resonate with these findings. HIV is a lens through which a whole range of social determinants and health inequities are refracted, if we choose to look for them. However, HIV can be a model for enacting our social worlds differently to mitigate and challenge the fundamental causes of inequity.