Being Connected Is the Key to “Survival of the Fittest” for HIV-positive Women

by Kathleen Belanger

In rural communities, we may not always have specialists, specialized treatments or facilities for specialized interventions. But sometimes, we actually do have the best of the best.

In my last column, I highlighted Pathways Vermont, a program that has decreased homelessness in rural Vermont by adapting the evidence-based Housing First model to rural communities.  The program provides each person with a caseworker who connects him or her to housing and to the community. The client is also connected to a team of specialists often using technology, but assisted by the local caseworker.  The results are decreased homelessness and increased independence, well-being and cost savings.

This month I'm highlighting yet another rural success story, one of the Special Projects of National Significance that reaches those who suffer the most, and which helps regenerate hope and community, with human services placing a critical role.

Special Health Resources for Texas, with headquarters in Longview, Texas, has received a grant from HRSA to find women of color who are newly diagnosed with HIV, to help them obtain medical assistance during their illness and maintain their medical regimen.  The grant, called Survival of the Fittest, utilizes a multidisciplinary team approach including social workers, case managers, nurses, doctors, dentists and other specialists, as needed.  The case manager (or other significant member of the team) is available to be with the client when needed, even at telemedicine appointments. Social workers call the client at least once a week, and often twice a week, and this continuous though relatively inexpensive support leads to increased treatment adherence, fewer missed appointments, fewer hospital stays, and better physical and mental health.

The program is evaluated through stakeholder studies (surveys) at baseline, then at three, six, 12 and 18 months. It is also evaluated through the telling and analysis of "survival stories," a kind of participatory action research that not only provides qualitative information about the challenges and resilience of the fastest growing HIV population, but also leads women to learn about themselves and, at times, rethink their lives.  And this may be the key to the program's success.  The participants have people who call them, who care about them, and who want to know about them and listen to their stories.  This, in turn, causes the women to listen and reflect, and value their own lives.

According to Emmerentie Oliphant, PhD, Professor and Director of the MSW Program at Stephen F. Austin State University and evaluator of the project, "The women came from being in need of help to being partners in their own treatment; from being isolated in their diagnosis to belonging; from being in denial to facing their challenges; from being hopeless to inviting change in their lives."  In addition to their HIV diagnosis, many of the women lack insurance, funds for treatment or co-pays, and adequate food or shelter.  Focusing on strengths and solutions as part of a team helps them reconnect with others and meet these significant challenges.

And faced with the common rural challenges of transportation, poverty, unemployment and sometimes language barriers that hinder their ability to receive health or mental health care, the team approach and the skills of social workers and case managers, along with the ability to provide telehealth and telemental health, removes barriers to treatment and creates community.

According to the evaluation findings, by working continually with someone who listens and collaborates, who will stay the road with them (the case manager and social workers), and by receiving treatment through a team, the women find a sense of belonging and meaning, giving purpose to their lives. Instead of being isolated in fear, they find themselves connected to others who have suffered and who have faced the stigma of HIV, and connected to those providing medical attention, thus increasing compliance and active participation in their and long-term health and mental health.  Or as Oliphant, who received the University's Bright Ideas Research Award for her work on this grant, says: "Feel my hurt, feel my pain, see my strength."

This is how rural communities can best help those most in need: through finding strengths, making connections, and providing a local case manager, a local person adept at listening, not just for the challenges but for the strengths, and adept at linking locally and regionally to those who have the specialized skills to help.  And perhaps this will be how we can document the survival of our fittest communities: by assuring there are local case managers who can listen, support, partner, refer and link locally, and by providing the specialists and individualized interventions through technology and with the assistance of the personal local human service professional:  by being connected.

Kathleen Belanger, Ph.D., is Associate Professor of Social Work at Stephen F. Austin State University in Nacogdoches, Texas, and is a member of the RUPRI Human Services Panel, co-chair of Child Welfare League of America (CWLA) National Advisory Committee on Rural Social Services, and recipient of CWLA's Champion for Children award in 2005 for her work in rural child welfare. Belanger has published and presented on human services issues in a variety of publications and forums. In addition, she has worked for more than 20 years with rural communities, where she has helped found several non-profit organizations and advocated for rural resources.

Opinions expressed in this column are those of the author and do not necessarily reflect the views of the Rural Health Information Hub.

Back to: Spring 2014 Issue