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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:
What Can Be Done Better to Allow for Easier Access to HIV Care
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.
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.
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.
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.
What do you think can be done better to allow for easier access to HIV care? Join the discussion in the comments section.