Solving the Challenges of HIV
When HIV/AIDS first emerged in the 1980's, few treatment options were available. Services were limited to palliative care - the average person could expect to live only a few years upon entering the "symptomatic period". In the early years of the epidemic, little was known about HIV disease. Testing was not yet promoted as a public health campaign and was relatively inaccessible. The overwhelming majority of individuals were diagnosed only after presenting multiple symptoms, when the disease had already progressed enough to cause significant damage to the immune system.
For health and human service providers, the primary focus was on assisting clients with immediate, short-term needs to alleviate their symptoms and to prepare for their death. The Long Island Association for AIDS Care, Inc. (LIAAC) was established in 1986 to assist Long Islanders living with HIV/AIDS and their families facing the problems associated with this life-threatening illness. LIAAC's case management services helped HIV+ individuals address their urgent medical and social service needs; many clients initiated receipt of agency services when they were in the final stages of their illness. Clients were assisted primarily with locating a medical provider knowledgeable in HIV, securing health insurance coverage, and locating a home health care provider, hospital, and/or hospice. Supportive services were available to help clients secure life insurance, establish a living will and health care proxy, and make burial arrangements. Case managers had a limited time to get clients' affairs in order, as the disease rapidly progressed in the absence of effective medications. LIAAC's services also extended to clients' families coping with the stress of losing a loved one, including respite for adult caregivers and bereavement groups.
With the introduction of Highly Active Antiretroviral Therapy (HAART) regimens in 1996, the progression of HIV disease has been permanently altered, greatly impacting HIV/AIDS service delivery. The availability of a large variety of effective antiretroviral medications has allowed HIV+ people to live longer, fuller lives. In most cases, HIV/AIDS is no longer associated with a short life-expectancy upon diagnosis; its management now closely resembles that of a chronic disease. In this day and age, the emphasis is on maintaining a healthy immune system through regular medical monitoring by an HIV specialist and through routine preventative care. Many HIV positive individuals are living into their 50's and beyond and thus have a greater chance of developing other, non-related diseases associated with old age, such as diabetes, hypertension, heart disease, and vision problems.
LIAAC's services have evolved to meet the changing needs of our clients. Over the last several years we have seen a drastic change in the epidemic. HIV+ individuals seeking our services have presented with a multitude of needs that were not as prevalent in years past, including substance abuse issues, chronic mental health problems, Hepatitis C and sexually transmitted diseases (STDs). Today, HIV/AIDS often is not the primary concern of individuals who are requesting our services. In order for our staff to address any HIV issue, our staff must now address some of these other barriers, e.g., substance abuse and mental health issues, before making any progress in catalyzing access to treatment for HIV/AIDS. This shift in priorities has directly impacted the manner in which LIAAC serves people living with HIV/AIDS and the type of grants we are pursuing and being awarded. New services included in recent grants awards to address these new emergent needs include: Hepatitis prevention, substance abuse readiness and assessment, comprehensive risk assessments, at-risk and prevention case management, STD prevention education, and Crystal Meth education.
The Long Island Association for AIDS Care is distinguished by both its ability to provide high-quality services and its propensity to successfully anticipate, monitor, and preemptively adapt to the evolving challenges presented to people infected or affected by HIV disease. By combining big-picture awareness of trends in HIV disease, treatment, and transmission trends with micro- (individual-focused) situations and total personal health and wellness, LIAAC is exceptionally well positioned to continue solving the challenges of HIV effectively.