America Living With AIDS

A M E R I C A Living With A

Medicaid programs, this is especially
so in those states with home and community-based waiver programs. Yet
other programs have emanated from
prepaid, managed care programs in
health maintenance organizations.
The success of a case management
program is to a certain extent contingent upon the availability of a spectrum of necessary services.
The Commission believes that case
management programs should be supported and further refined to meet the
particular needs of people with HIV
disease. Case management offers not
only the potential for saving costs,
limiting hospital stays, and bringing
coherence to service delivery, but also
may enhance satisfaction and quality
of life for those with HIV disease.
Assuring A'vailability of I I cui
Care Prov idcrs
As the number of people with HIV
disease grows, the availability of health
care practitioners is an increasing concern. The complexity of care for HIV
disease (especially in its later stages) is
such that no single medical specialty
or discipline encompasses all the necessary skills.
Infectious disease and oncology
specialists were initially cast in the
role of primary caregivers in the HIV
epidemic. However, as the epidemic
has progressed, internists, family
medicine practitioners, obstetrician/
gynecologists, and pediatricians have
had to incorporate the care of HIV
disease into their general practice.
The Commission believes that primary care providers should be able to
counsel about HIV transmission risks;

diagnose and treat early HIV disease;
monitor patient care; and recognize
complications later in the disease process that require consultations from
specialists or referrals.
Despite the great need for services
for people with HIV disease, health
care providers have often been reluctant to care for them. The reasons
include low reimbursement rates for
people whose care is paid for by Medicaid; a lack of familiarity with and
understanding of treatment for the
disease; fear of becoming infected
during the course of treating patients;
discomfort in treating gay men or
intravenous drug users; and unease in
dealing with the psychological stresses
of caring for dying young patients
with multiple physical and psychological needs.
The Commission believes health
care practitioners have an ethical
responsibility to provide care to those
with HIV disease. Lack of specialized
knowledge, concerns about the risk of
HIV transmission, increased stress, or
disaffection with those who are at risk
are not reasons to avoid caring for
individuals with HIV disease, although
these concerns are real, pervasive, and
must be dealt with directly. The following section looks at ways to address
these concerns in order to attract,
train, and support sufficient numbers
of health care providers to meet the
challenge of HIV disease.

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