Thursday, April 10, 2014

From a social worker who works with pediatric and pregnant HIV+ clients #saveryanwhitepartd #nyhaad

As a social worker who serves pediatric and pregnant HIV positive clients, I am concerned to think that the targeted prevention, treatment, and retention efforts that RW Part D makes possible is in jeopardy.  Admittedly, we have come a LONG way since the ‘dark days’ of the outbreak; back then, we could scarcely imagine that a pregnant positive woman who is treatment adherent could be almost 100% assured of having a negative infant, with perinatal transmission rates nationally at less than 1-2%.  It would also have been a stretch to imagine the strides in HIV treatment, such that today’s HAART meds give clients their lives and health back, with medication adherence and unobtrusive regimens.    
Because of these advances, the U.S. is seeing fewer positive children, a joy to report (as my colleagues and I love to say, we can only hope that we will be out of a job some day).  These children are ‘ageing out’ of our care and transitioning to Adult ID care.  On the flip side, the U.S. is seeing a precipitous rise in newly diagnosed MSMs and teens.
Yes, there has been amazing progress. However, until HIV is eradicated, I believe that to ease up on our efforts, despite our successes, portends resurgence.
Much of what I do day-to-day can be called ‘relationship-building’—care coordination, outreach, personal communication, resource referral, follow-up; and medication, safer sex, and sexual health counseling.  Such ‘soft’ interventions can be challenging to quantify, if not justify. Yet, evidence-based research is bearing out the critical importance of ‘relationship’ in positive patient outcomes.  As an example of what Part D funding allows me to do, and how relationship-building comes into play:  I am sanctioned to meet monthly with an interdisciplinary team comprised of  university, medical center, community, and regional providers, for the purpose of reviewing, case by case, pregnant women who have entered our care, as well as women who have delivered. We have found this ‘touching base’ to be indispensable in catching and addressing issues before they become problems.  Prior to delivery, I meet with the mother-to-be and introduce her to our “Exposed Newborn Protocol,” per federal guidelines; this describes the care her infant will receive for 4 months post-partum, namely, 3 clinic visits that include HIV testing (to establish a definitive diagnosis), an exam and consult by our Drs., and a medical case management visit from me that addresses the mother as well. Part D pays for these services.
In disclosure, RW Part D covers 25% of my salary; RW Part B covers 75%.    
Mr. President, thank you for your consideration of conserving this baseline safety net for countless HIV positive women and their infants.  
Susan H, LCSW
North Carolina
#SaveRyanWhitePartD #NYHAAD

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