America Living With AIDS

AM E R I C A Living With AIDS

retard the onset of symptoms, as well
as benefit from social and mental
health services. Unfortunately, many
of these people have no point of entry
into the health care system. Millions
of Americans have no health coverage,
and even those people living with HIV
disease who have some form of public
or private insurance may still face
formidable barriers in gaining access
to needed care.
DE \VEL OPING A
There is a range of services needed by
people living with HIV disease and
increasing agreement about where and
how to provide such services. Ideally
what is needed is a continuum of care
ranging from minor help for people
living at home to congregate living
facilities with support services to
skilled nursing care for more dependent persons in nursing homes. There
is no single model of care that is appropriate for all communities. Nevertheless, in its travels around the country,
the Commission discovered a number
of elements indispensable for delivering continuous and comprehensive
services for people with HIV disease.
These include:
* HIV antibody testing that is voluntary and must be accompanied by
counseling-both anonymous and
confidential testing contribute in
different ways and both options
should be available;
* education and counseling to help
foster and maintain behavioral
changes to reduce transmission of
the virus;

* medical care, including drug therapy and frequent diagnostic monitoring, ongoing primary care, coordination of inpatient and outpatient
care, access to investigational new
therapies, and adequate options for
long-term care;
* psychological care, including mental health counseling and spiritual
support, that is helpful in coping
with a frightening and sometimes
overwhelming condition;
* drug treatment to help individuals
stop using or injecting drugs or
adopt safer drug use practices; and
* social services, including a range of
housing options and income maintenance, without which medical
advances may be beyond the grasp
of those who could most benefit
from them.
The medical services needed by
people living with HIV disease require
a multidisciplinary care approach in
which a team of health care providersincluding primary care physicians and
consultants in fields such as infectious
diseases, oncology, pulmonary diseases, psychopharmacology, and neurology-works together with patients,
their loved ones, and families to develop a plan for care.
A basic goal in developing plans of
care for people with HIV disease, as
with other illnesses, is to provide dignified and appropriate care in the least
restrictive and least institutional setting possible at the lowest possible
cost. Cooperation among caregivers is
essential in ensuring that a true continuum of care is available, from the
time an individual first becomes aware
he or she is at risk or learns of HIV

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