By Steve Smith
Celebrating its 30th anniversary, the ACE (AIDS Care & Education) program is a jewel in the crown of Lutheran Social Services (LSS) of Northeast Florida. Serving more than 1,200 clients annually, it’s one of the few initiatives in Northeast Florida that provides “wraparound” services – such as case management, mental health services and education – to people living with HIV or at risk of HIV infection.
More recently, a flourishing partnership with CAN Community Health has enabled the program to expand, providing a “one-stop center” for people living with HIV in the Jacksonville metropolitan area, connecting them with the medical and non-medical resources they need to thrive.
Poverty, social stigma and other factors fuel the HIV epidemic
In the South, America’s HIV epidemic is driven mainly by poverty and lack of access to healthcare. The southern states have the highest poverty rate, the lowest median household income, and the greatest percentage of uninsured people (Florida is one of 12 states, most of them in the South, that have not adopted the expansion of Medicaid).
In northern Florida, several factors have kept the HIV rate stubbornly high, especially in gay and bisexual men of color. These include “deep south” social stigma, high poverty, and the lingering effects of the opioid crisis. The slow uptake of prevention methods like syringe services programs (needle exchanges) have increased the risk for acquiring HIV and hepatitis C (HCV). In this community, to say the level of need is great would be an understatement.
According to TheBody.com website, as of 2017, greater Jacksonville had the ninth-highest rate of new HIV diagnoses in the country. AIDSVu, a website housing interactive online maps allowing visitors to visually explore the HIV epidemic in the United States, shows there were 7,129 people living with HIV in the Jacksonville Metropolitan Statistical Area in 2019. The rate of people living with HIV per 100,000 population in 2019 was 652, and 322 people were newly diagnosed with HIV.
We’ve come a long way
Bill Brim, president & CEO of Lutheran Social Services of Northeast Florida, is a Florida native and former banker with deep roots in Jacksonville. According to Brim, Jacksonville fits the profile of the southern community where the stigma of HIV forces the newly diagnosed and non-diagnosed alike to live in the shadows. Many are at risk, but for fear of becoming social outcasts don’t want to know their HIV status and do not access care. This is where the education component of a program like ACE can make a difference.
“We’ve come a long way,” Brim says. “But for some people, it’s just ‘taboo’ to deal with, so they don’t want to know their HIV status. Sometimes it’s not for fear of social stigma, it’s because they’ve heard the medications cost thousands of dollars per month. But it’s likely they don’t know about lifelines like the Ryan White program that are here to help them.”
According to information on the Florida Department of Health website, to be eligible to receive benefits under the Ryan White program in the state of Florida, you must be HIV positive, living in Florida, and not receiving the same services from Medicaid or insurance, and you must have an income at or below 400 percent of the Federal Poverty Level. Services covered under the program include doctor visits, dental care, prescriptions, case management, health insurance premiums, transportation, housing and other support services.
Partnership with CAN enables a holistic approach
The partnership between CAN and LSS in northeastern Florida was conceived in early 2016. Taking full flight with the new facility’s opening in 2018, the partnership broadened the scope of services LSS was able to provide. The addition of medical and dental care, and a full-service pharmacy, made the agency’s offerings more robust, filled a void, and added considerable value for LSS clients.
Today, some 120 people work in the facility, serving the largest HIV population under care in Jacksonville. Under this single roof, clients can see their doctor, receive dental care, get prescriptions filled at the pharmacy, see their case manager and peer navigator, get food at the LSS Food Pantry, and receive housing assistance in conjunction with another program called Housing Opportunities for Persons with AIDS (HOPWA). Some clients also take advantage of an LSS career and financial counseling program called Steps 2 Success.
But this unification of services goes beyond convenience and efficiency. It enables a holistic, solutions-driven approach to care that has formed a stronger connection with clients and resulted in high viral suppression rates.
A better client experience
Compared with the client experience at other facilities, staff members spend more time with patients, gathering more information and being more attentive to their concerns. According to Bill Brim, “Strong communication between physicians and case management staff sets this program apart from others. Our case managers really do connect and build a genuine rapport with clients. That can have a strong impact on clients’ lives.”
Brim also attributes the program’s success to the stability of the staff. Noting the high staff turnover rate some healthcare providers are experiencing, he’s proud to report that members of the medical staff who joined the clinic when the facility opened in 2018 are still seeing patients there today.
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