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Overcoming Challenges in HIV Care Settings: A Patient Advocate’s Perspective

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Chelsea Gulden

Chelsea Gulden has no relevant financial relationships to disclose.

View ClinicalThoughts from this Author

Released: September 19, 2022

Key Takeaways

  • The following steps can be taken to reduce barriers to accessing HIV care in clinical settings.
    • Increase staff training and accountability for cultural sensitivity.
    • Increase use of interdisciplinary models to ensure that involving support staff—even from other organizations or entities—is a priority.
    • Ensure that the layout and structure of the clinical setting prioritize privacy.
    • Allow for increased flexibility in policies and procedures.

As a person who has lived with HIV for almost 20 years and worked in HIV for 19 years, I have experience with accessing and providing care. This dual lens is insightful for determining changes that are realistic for healthcare professionals and impactful for patients. As a patient, I think it’s important for healthcare professionals and the healthcare system to hear about our needs and perspectives on how to improve care, decrease stigma, improve retention, and provide a better overall continuity of care.

Here are what I think are the most impactful ways to improve access to HIV care and address barriers to care at the clinic level.

First, keep in mind that, from a patient’s perspective, HIV treatment and medical care often are provided in a cold space with stringent guidelines that create additional barriers for those who already may be facing psychosocial, structural, and other barriers to accessing HIV treatment and care.

Some of the barriers to care in traditional clinic settings include:

  • Phone systems that often place people on hold for long periods or are too complex to get a live person on the line
  • Time constraints or grace periods that are difficult to adhere to when relying on public transportation
  • Lack of privacy in open waiting rooms.
  • Lack of empathy from clinical staff members
  • Lack of support, including from involved support agencies

What Can Be Done Better to Allow for Easier Access to HIV Care

Increase Support
Clinical staff should take extra time to involve support agencies and support people, especially if the supporters are not employed directly by the clinic but are part of an outside entity. This additional time allows patients to feel increased security and comfort as they access care, and it helps with navigating challenging phone systems and other structural barriers to care. Increased use of interdisciplinary models should ensure that involving support staff—even from other organizations or entities—is a priority.

Increase Empathy
Clinical staff should have ongoing sensitivity training to increase empathy, and all staff should have training and accountability for cultural sensitivity. Management will need to help the staff understand how to put the training into practice and hold them accountable for doing so.

Increase Privacy
The layout of clinics should be constructed with privacy as a priority. Many clinical spaces have open waiting rooms or signs pointing to the infectious disease area. This open setting, particularly in smaller communities, can be a deterrent for some individuals seeking care. While sitting in the waiting area, people may wonder if the person next to them is there for HIV care or worry that others are wondering this about them.

Increase Flexibility
Finally, structure that allows for increased flexibility should be built into policies and procedures. Availability for walk-in or evening hours would allow patients with competing daytime priorities and who are reliant on public transportation to easily access HIV treatment and care.

Your Thoughts?
What do you think can be done better to allow for easier access to HIV care? Join the discussion in the comments section.

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