Keith: “The only thing we have to fear is fear itself”
Fear of disclosing HIV status is one of the primary barriers for our clients in obtaining health care. Not surprisingly, such fears are quite common. Widespread discriminatory attitudes and hostility to people living with HIV provokes such fear. Discrimination and social ostracism often occur — but don’t need to — when people tell family, friends or acquaintances that they are living with HIV.
One of our clients — “Keith” — is a good example of how our Philadelphia Linkage Program (PLP) medical-case-management services successfully address such fears. Keith, a 35-year-old African-American man, was referred to the PLP when he tested positive for HIV while in the Philadelphia Prison System in 2014.
A PLP case manager began working with Keith while he was still in jail. When the time came for Keith’s release from jail, his case manager continued to work with him, smoothing his re-entry to the community.
Keith had a difficult time accepting and understanding his HIV diagnosis. Many people living with HIV go through similar periods of denial. In Keith’s case, he was also afraid he’d lose his connection to those in his life.
In a one-on-one discussion, Keith and his case manager addressed and expanded his comfort level when thinking about means of HIV prevention, medication-adherence techniques and secondary prevention strategies, to assist Keith in better managing his health care. Through this ongoing relationship and continuous communication with his case manager, Keith overcame his fear, and realized the benefit of being open about his HIV status with those in his life. He‘s now told his family, who have accepted him, resulting in a profound sense of liberation from the stigma of HIV.
At the same time Keith was overcoming his fear of letting people in his life know his HIV status, he continued to be actively involved in his health care, including HIV care. He’s continued this care to this day. He persuaded his partner to get involved in prevention services. Keith and his partner are now being counseled on HIV prevention and have begun Pre-Exposure Prophylaxis (PrEP). Because of his success in working with the PLP case manager, Keith now works with a long-term medical-case management with ActionAIDS.
Katherine: From a dark beginning, a brighter future awaits
For many people with HIV, their story of dealing with the disease goes back many years to their early childhood, perhaps even to the previous generation. “Katherine” is one such client.
HIV has been a part of her entire life. Her mother was living with HIV at the time of her pregnancy with Katherine. Katherine then was infected during pregnancy and/or childbirth.
Her infancy and toddler years with her birth parents were traumatic, and by her adolescence, Katherine was being bounced among foster-care and group homes. In 2014, at age 21, she was briefly jailed because of a minor probation violation. As an inmate living with HIV, she was referred to a Prison Linkage Program (PLP) medical-case manager from ActionAIDS.
Although meeting PLP staff was probably one of the best things that could have happened for Katherine while she was in jail, at first she was fearful of her PLP case manager. Nevertheless, over time, and thanks to the case manager’s persistence, Katherine and her case manager developed a relationship based on trust.
Katherine was then able to open up. She shared that she was concerned about her ability to make sound decisions and, worse yet, didn’t know where she could live upon release from jail. She also didn’t know where or how to access health care as an adult, as she had previously received her health care as a teen.
Katherine worked with her medical-case manager to have a plan in place that would address these questions. She was able to identify an appropriate community-medical provider, and was able to get an appointment with them right away. She also receives behavioral health services and attends a daily counseling group as part of that program. She and her medical-case manager submitted an application for Social Security benefits, and she is awaiting receipt of income. She is on a waiting list at this time for a transitional housing program for young adults. But the most inspiring positive development in her life is that she successfully applied for admission to Community College of Philadelphia and completed her first classes over the summer.
Looking to the future in another way, Katherine is proactive in her medical care and sticks with her medication treatment schedule. Her HIV viral load is undetectable. Yet again, with the support of medical-case management services from ActionAIDS, another person with HIV in the Philadelphia area is helping to create the first AIDS-free generation.