Six Point Plan to Respond to HIV/AIDS in Illinois

Based on the suggestions gathered from more than 100 community members at input sessions across the state hroughout 2008, the AFC Policy Committee prioritized the following initiatives that policymakers should consider to combat the HIV/AIDS epidemic in Illinois.

1. Promote Comprehensive Strategies to Prevent HIV Transmission

• Prioritize HIV prevention for gay/bisexual men of all colors
• Respond to the intersection of HIV and incarceration
• Address the unique HIV prevention needs of youth, women, and people over 50
• Promote statewide comprehensive, age-appropriate, and medically accurate sex education programs

“We still have to treat HIV/AIDS as one of the worst plagues in human history. We can’t treat our way out of this epidemic... We have to halt the spread of the virus,” said David Ho, MD, director of the Aaron Diamond AIDS Research Center, speaking on the Charlie Rose Show in January 2009. In 2008, the U.S. Centers for Disease Control and Prevention (CDC) underscored the nation’s HIV prevention challenges when it reported that an estimated 56,000 individuals become HIV-infected each year, a figure 40% higher than previously estimated. In Illinois, as many as 3,000 or more individuals become infected annually. To reverse these tragic trends, HIV prevention must be bold, science-based, responsive to the particular needs of impacted communities, and adequately funded. Governments must support a comprehensive array of services—focused on where the needs are greatest—to change individual behavior and the systemic, structural factors fueling HIV transmission.

2. Prioritize Public Health

• Invest in core public health infrastructure
• Ensure adequate workforce with requisite expertise
• Partner with community stakeholders

A strong public health sector is essential to the fight against HIV/AIDS. Public health leadership leverages greater cooperation from government and community stakeholders to research, plan, deploy, and evaluate an array of science-based activities to fight the epidemic. Despite many committed and talented public health professionals working on HIV/AIDS across Illinois, the sector as a whole remains inadequately funded and staffed. Many longtime professionals with HIV/AIDS expertise have retired or exited the field. Our state and local governments are slow to fill vacant positions and many essential jobs have been eliminated altogether. For example, staff cuts at the Chicago Department of Public Health have depleted clinical services, grant-writing, public health planning, and research activities needed to respond to HIV and other public health concerns. More than a dozen staff positions in the Illinois Department of Public Health’s HIV/AIDS Section have remained vacant for more than a year, although they are fully funded by the federal government. Without a skilled and adequate workforce, public health cannot respond to trends in the epidemic, award and monitor grants to capable community-based agencies, provide technical assistance to community-based agencies, and implement essential services. Lawmakers must prioritize public health in budgetary appropriations, attract the best and brightest to the field, and ensure the sector is able to fulfill its important mission. The public’s health is too important to do otherwise.

3. Break the Cycle of Sexually Transmitted Diseases (STDs)

• Increase funding for STD services
• Expand prevention, screening, and treatment programs
• Implement innovative strategies, including Expedited Partner Therapy

According to CDC, Cook County has the highest number of gonorrhea cases and the second highest number of chlamydia cases of any county in the United States. Some downstate communities have sexually transmitted disease (STD) infection rates that are equal to or greater than those in Chicago. Greater urgency is needed for efforts to prevent, diagnose, and treat STDs in Illinois. Research shows that people with untreated STDs are at significantly higher risk of HIV infection than those without STDs. Conversely, HIV-positive people co-infected with an STD may inadvertently spread HIV more readily because STDs increase concentrations of the virus in the genital tract. STDs in Illinois
disproportionately impact distinct and overlapping populations of sexually active youth, people of color, and gay/bisexual males. A comprehensive response to the HIV/AIDS epidemic must embolden efforts to combat STDs statewide with increased government financing for STD prevention and treatment programs; expanded, community-based STD prevention, screening, and treatment programs; and innovative strategies, such as Expedited Partner Therapy.

4. Improve Access to Healthcare and Support Services

• Improve healthcare access for all
• Address the mental health needs of people with HIV/AIDS
• Improve care for individuals dually diagnosed with HIV/AIDS and hepatitis
• Respond to unmet transportation needs of people with HIV/AIDS

Essential healthcare and support services needed by people with HIV/AIDS remain in short supply. An estimated one in two HIV-positive individuals in the U.S. are disconnected from HIV-related healthcare that could dramatically improve survival. Poverty, lack of health insurance, HIV-related stigma and discrimination, and a variety of other factors impede greater utilization of HIV-related services. Because so many barriers affecting people with HIV/AIDS are widely shared by others who are low-income and lack adequate health insurance coverage, comprehensive solutions to the nation’s fragmented healthcare system offer the greatest promise.

Meanwhile, several statewide initiatives merit Illinois lawmakers’ attention. The state should expand Illinois Cares RX Plus—a program designed to help low-income elderly individuals afford healthcare—to all disabled, low-income Medicare-enrolled Illinoisans regardless of diagnosis. Illinois must adopt numerous reforms to make Medicaid more accessible. The state’s flagship HIV treatment access program—the AIDS Drug Assistance Program—would better meet clients’ needs by adding mental health and viral hepatitis treatment medications to its formulary. Finally, state officials should devise new ways to provide rural and urban low-income clients transportation to essential service
appointments. In rural areas, where HIV services may be 50 or more miles away, great distances make it difficult if not impossible for low-income individuals to regularly access the services they need.

5. Ensure Safe, Affordable Housing for People with HIV/AIDS

• Increase housing options for formerly-incarcerated individuals living with HIV
• Tailor services for homeless substance users, including harm reduction housing

Thanks to a multi-year research project led by the AIDS Foundation of Chicago, scientific evidence now exists to substantiate the cost-effectiveness and health benefits of
permanent, supportive housing for low-income people with chronic, medical conditions, including HIV/AIDS. Safe, supportive housing can help stabilize individuals medically and reduce risk-taking behaviors. With stable, permanent housing, clients are more likely to adhere to medical regimens and reduce their reliance on costly emergency room visits, inpatient hospitalizations, and nursing homes. While state and federal agencies have thankfully invested in an array of HIV-related housing services, the need for safe, affordable housing continues to outpace available resources. Two, often overlapping,
populations with acute, unmet housing needs are HIV-positive individuals returning from prisons and jails and people who suffer from substance abuse and HIV. Governments should increase investments to expand housing options for these populations.

6. Build Dignity through Work and a Living Wage

• Prepare people disabled by HIV/AIDS for work
• Create job opportunities for HIV-affected individuals
• Maintain access to publicly-funded benefits to support the transition to independence

Thousands of low-income, disabled Illinoisans with HIV need help re-entering the workforce without jeopardizing the very benefits that bolster their health. As antiretroviral medications revitalize many individuals who once were on their deathbeds, government policies make it next to impossible for people with disabilities to pursue work without destabilizing losses of Medicaid, Medicare, and other benefits. Moreover, the poor economy makes entering the workforce challenging for individuals who, because of illness, have extensive resume gaps; others have few skills or experience to start the path toward economic independence. Government assistance programs must stop penalizing work. Programs helping people with HIV explore options, prepare for the workforce, and obtain employment deserve increased government support. Programs are also needed to reduce HIV-related stigma among employers and provide specialized skills development for workers. Gainful employment instills a sense of self-worth and dignity: the very attributes many people with HIV desperately want and need to achieve greater independence. And eventually, work will help many people with HIV to leave government programs behind, contribute to the tax rolls, and live self-sufficiently.

< Back Next >

Introduction

The Work Continues

Federal

Six Point Plan

For the Record

Illinois HIV/AIDS Statistics

2009 Policy Priorities
PDF Format