ACA+HIV: A Frontline View

Earlier this month, San Francisco HIV frontline workers convened to discuss San Francisco’s HIV systems of care and the effect of the Affordable Care Act (ACA) on these systems.

Over 50 frontline workers from 19 different organizations joined the conversation. Participants included case managers, benefits counselors, social workers, peer advocates, and medical providers.

San Francisco HIV Frontline Workers

Andy Scheer presents on changes in the HIV Systems of Care

The meeting opened with welcomes from Dean Goodwin, HIV Health Services Administrator of the San Francisco Department of Public Health and Shannon Weber of Getting to Zero, a coalition of organizations whose goal is to get to zero new HIV infections, zero HIV deaths, and zero HIV stigma in San Francisco.

Following their remarks, Andy Scheer, a medical social worker at SF City Clinic, gave a presentation on the ACA and changes in San Francisco’s HIV systems of care. Andy’s comments addressed greater accessibility of health insurance through Medi-Cal expansion and Covered CA (the healthcare marketplace established by the ACA); the intersection between health insurance, public benefits, and taxes; the impact of same-sex marriage on access to government benefits; and changes at the local level, such as SFDPH’s shift away from a specialized care clinic model to an integrated treatment model.

Keeping up with all these changes is challenging, and in a quick survey of participating frontline workers, seven out of ten responded that the ACA makes them want to “hide under their desk.” However, attendees recognized the importance of HIV frontline workers being fully informed and having up-to-date information about systems of care to best serve San Francisco’s HIV positive community. Though it is difficult to keep up with and adapt to all of the changes in HIV systems of care, the continued hard work of frontline workers is worthwhile because the changes brought by the ACA will ultimately strengthen the healthcare system and make care more accessible.

Making changes in the HIV systems of care is necessary to better address the wide range of issues facing HIV positive individuals. Some of the specific needs identified at the frontline convening include:

  • stable housing
  • access to food
  • benefits advocacy
  • insurance and healthcare access
  • support for mental health issues

Many of the HIV frontline workers in attendance commented on the need for a holistic approach to HIV advocacy and care in the city to address all of these complex and interrelated issues.

One of the main concerns that surfaced from the convening is the San Francisco housing crisis and its impact on increasing homelessness among people living with HIV. Homelessness can exacerbate health problems and make it much more difficult for individuals to access care. For example, if an HIV positive individual is homeless, that person is unable to store medications that require refrigeration. Homeless individuals have no safe space of their own, which takes a toll on their physical safety and mental health. Because homeless individuals are more likely to be robbed, lack of housing may also result in medications being stolen. Homelessness also makes it harder for advocates and healthcare providers to get in touch with these individuals, making it more difficult to keep them engaged in care and connected with important resources and programs. These are just a few of the many challenges homeless individuals face. In order for HIV positive individuals in San Francisco to thrive, we need to assure that their basic needs, including access to secure housing, are met.

Another key issue that came up in the discussion is the need for more AIDS Drug Assistance Program (ADAP) and the Office of AIDS Health Insurance Premium Payment Program (OA-HIPP) enrollment workers in the city. Many attendees also commented that the California Office of AIDS seems underfunded and understaffed, which causes challenges in resolving clients issues.

After small group discussions, participants share insights with the rest of the group.

After small group discussions, participants share insights with the rest of the group.

Frontline workers also emphasized the need for wraparound case management for HIV positive individuals, strategies for keeping clients engaged in care, importance of networking and inter-agency communication, and ways to avoid burnout in this challenging (but rewarding!) line of work.

This meeting was a great opportunity for identifying issues and brainstorming solutions, as well as forging stronger bonds between the many wonderful HIV advocacy organizations and healthcare providers in San Francisco. We look forward to keeping the conversation going and continuing to create a stronger network of care for this vulnerable population.


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