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New Act Strengthens Local Ties

“I was 17 years old and newly married when I found out that my husband had HIV and had infected me. A year later he was dead,” says Luisa, a 24-year-old, soft-spoken mother of two. When she moved to Denver from Mexico, she connected with a social worker named Maria Lopez. “She was my first case,” says Maria, “and we’ve become great friends.” With Lopez’s help, Luisa, who still speaks very little English, learned to manage her disease. In fact, she’s never missed an appointment.

Today, Luisa is receiving care at La Clínica Tepayac, a Denver provider serving primarily Hispanic clients. In part because of the Ryan White HIV/AIDS Treatment Modernization Act of 2006, which created a new Part A Transitional Grant Area (TGA) program, Denver, a former Eligible Metropolitan Area, is able to continue to support not just a single organization like Clínica but a diverse set of organizations that together create a comprehensive system of care throughout the Denver region.

Service Offerings of the Denver TGA

The creation of TGAs is one of the most significant changes in the 2006 legislation compared with its predecessor, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. In 2008, there were 34 TGAs in the United States and Puerto Rico—in cities with a total population of at least 50,000 and between 1,000 and 1,999 AIDS cases reported in the past 5 years.

In Denver, the TGA program is coordinated by the Mayor’s Office of HIV Resources (MOHR). Each year, the Denver HIV Resources Planning Council, appointed by the Mayor, develops a plan for the delivery of HIV/AIDS clinical and support services.

“We use CAREWare to tell us a lot of information about who is getting care and the quality of that care,” says Lynn Hough, Program Director of MOHR (see the May 2007 HRSA CAREAction). “CAREWare is just one of the tools the Planning Council uses to establish service categories, collect and review data to prioritize needs, and allocate and distribute resources,” he adds.

The Denver TGA is always looking for innovative approaches to fulfilling the expanding needs of people living with HIV/AIDS. “We’ve created a type of ‘insurance pool’ in collaboration with our primary care providers for procedures that typically wouldn’t be covered, such as ophthalmology, dermatology, and specialty care,” Hough explains. “From the client standpoint, this improves their lives.”

Similarly, organizations like Clínica are finding ways of improving health confidence and addressing worries of people like Luisa. “My biggest concern has always been how to care for and protect my children,” she says.

Luisa is not alone. Lopez, who is now the project coordinator of the Planning Council, says that the concerns of the women who seek care at Clínica prompted them to conduct a series of workshops to give moms living with HIV/AIDS the parenting and disease management skills they need to care for their children.

Flexibility to Care for Patients

Mark Thrun, M.D., is co-chair of the Planning Council. He is also an infectious disease physician who is the director of prevention at Denver Public Health. Dr. Thrun says that one of the real powers of the Part A TGA-supported programming is that “it allows us to do what we really want to do—take care of these patients.”

Dr. Thrun understands the importance of getting people living with HIV/AIDS into care, and he and the other Planning Council members, many of whom are HIV positive, are passionate about keeping people in care. They do this by supporting linkages and building connections among organizations in the Denver TGA’s six counties. “Health is more than just coming into an office,” he says. “It extends into the community and into the home.”

When Epidemics Collide…

Bob Dorshimer is the executive director of the Council on Substance Abuse and Mental Health and founder of the Mile High Meth Project. He has seen the impact that the one-two punch of crystal methamphetamine (meth) addiction and HIV/AIDS has had on the gay community in Denver and surrounding areas.

While working in Denver’s Office of Drug Strategy, Bob discussed with Dr. Thrun the increasing incidence of HIV cases associated with meth in the Denver area. Soon afterward, Bob applied for Colorado Department of Public Health and Environment (CDPHE) funds to conduct evidence-based research about this burgeoning epidemic. He sent Rod Rushing, an HIV counselor and former meth addict, to study what other cities were doing to fight this new battle.

Bob has always worked to help others find renewed health and renewed hope. “I’ve been doing this work for 20 years. Social work is at the heart of my career,” he explains. And it is also at the heart of his home. Bob has adopted three sons, all from homes plagued by substance abuse.

When the CDPHE-funded study results came in, Bob and Rod went to the Denver Planning Council and MOHR with an idea—the Mile High Meth Project—which was soon approved for funding through Part A. Today, the Mile High Meth Project provides group and individual counseling services and support for men who have sex with men (MSM) and struggle daily with their meth addiction and HIV/AIDS status. Rod, now a counselor at the project, helps men battling many of the same demons he’s successfully overcome. “Once I found out that I was HIV positive in 1985, I started living like it was going to be over tomorrow. I was living on my 401k because I didn’t think I would be here long enough to need it.”

Many of the men in the program credit Rod with setting them on the course to recovery. Stephen gets emotional when he talks about Rod bringing him into the Mile High Meth Project. “I used meth every day for 15 years,” he says, fighting back tears. His rock bottom came when he was arrested for selling the drug in 2003 and landed in prison. Once he was released, he needed the skills to stay clean and to deal with his health issues. “It is a struggle, but the team at the Mile High Meth Project gave me the tools to make it work.” Stephen is proud to have his life on track and to be back in school because of this help.

The Mile High Meth Project is one of many initiatives that reflect what Dr. Thrun sees in today’s epidemic in Denver. Although medications have helped people do better in care, he adds that uncontrolled substance abuse such as meth addiction has meant more deaths because patients simply can’t manage their care sufficiently.

Unlocking the Key

When Imani Latif moved to Denver after many years in the New York City Health Department, she was burned out and convinced she’d never work in HIV care again. But then she had a vision. “I remembered a time when care was more a family thing and I wanted to bring that back. I also saw how some organizations were very afraid of working with people released from prison. But to us it’s not scary, because they’re our brothers, husbands, fathers, sisters, friends.”

It Takes a Village (ITAV) was built on the mantra that helping people living with HIV/AIDS takes the entire community. Caseworker Tonya Rozencwajg agrees with this principle:

“When I see people for the first time, they have no plan, no meds, and no support,” Tonya says. To help people living with HIV/AIDS transition from prison to community care, Tonya collaborates with many other players, including the case manager within the Department of Corrections, and links consumers into the Housing Opportunities for Persons With AIDS program. She also helps build relationships with organizations like Continental Divide Corporation, which hires ex-offenders who have successfully completed care programs at ITAV.

ITAV is a place where people of color with histories of incarceration can engage in care, find job training, access substance abuse and support services, and find hope for the future. It’s also a place where people can come and sit down on one of many couches and talk about their daily struggles or get clean clothes and a warm cup of coffee. ITAV is supported in part by Minority AIDS Initiative (MAI) funds, which have helped reduce the impact of HIV/AIDS among minorities through research, prevention, care, and treatment since 1999. (To learn more, see The HIV/AIDS Program: Minority AIDS Initiative.)

Monica, a transgendered client, found hope and acceptance at ITAV. “Coming out of prison, you don’t get a plan,” she says. “They stay on me and are like a little family,” she says. Thanks to the hard work she has invested in stabilizing her life, and with the help of ITAV staff, she sees a bright future that might not have been possible otherwise. Characteristic of so many Ryan White organizations, ITAV is striving to expand care wherever it sees a need. Monica is helping to contribute to this expansion by establishing the TransAction program—designed to support transgendered and transsexual people living with HIV/AIDS like her—at ITAV.

Imani is proud of the organization she’s created and of the passionate providers like Tonya who have helped Monica and many others transform their lives and start anew. Imani says, “This is what’s possible when you get a vision in your head and don’t let go.”