Advancing HIV/AIDS domestic agenda: social work and community health workers unite.
Article Type: Report
Subject: HIV infection (Care and treatment)
HIV infection (Prevention)
Social workers (Practice)
Social workers (Services)
Author: Wheeler, Darrell P.
Pub Date: 05/01/2011
Publication: Name: Health and Social Work Publisher: National Association of Social Workers Audience: Academic; Professional Format: Magazine/Journal Subject: Health; Sociology and social work Copyright: COPYRIGHT 2011 National Association of Social Workers ISSN: 0360-7283
Issue: Date: May, 2011 Source Volume: 36 Source Issue: 2
Topic: Event Code: 200 Management dynamics; 360 Services information Computer Subject: Company business management
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 255839654
Full Text: The Obama administration's National HIV/ AIDS Strategy (NHAS) (Office of National AIDS Policy, 2010) is the context for a watershed domestic HIV/AIDS agenda. This three-pronged approach of reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related disparities is both a long overdue and a welcomed strategic move. Social workers having long been engaged in HIV/ AIDS efforts (Wheeler, 2007)--will certainly appreciate this policy development as an opportunity for reinvigorating professional and community efforts in this arena. Even with this major national policy shift, the task of reducing the persistent disparities in HIV/AIDS incidence and prevalence among socially, racially, and economically marginalized groups is at best daunting. Changes in health care service delivery, immigration views and policies, and funding biomedical and pharmacological advances are a few of the many challenges social workers 30 years into the epidemic face. The landscape for HIV/AIDS service design, delivery, and evaluation will require advanced professional knowledge and renewed community-engaged efforts. In this new era of domestic HIV/AIDS focus, social work as a profession has a great opportunity to again demonstrate its worth in professional practice and community-engaged service delivery.

Bringing the best HIV/AIDS prevention and intervention services to the most at-risk individuals and communities requires community-informed and community-engaged responses. Social workers, while having much to offer, also have the opportunity to build on their professional knowledge and skills. In this regard, the community health worker (CHW; also known as peer-health and peer-health navigators) practice models could be highly useful for positioning social work at all levels (prebaccalaureate to advanced degree) to identify problems and mobilize resources that -will truly make a difference.

CHW MODEL

Spencer, Gunter, and Palmisano (2010) and Perez and Martinez (2008) clearly articulated complimentary aspects of the CHW and social ,work models of practice. Both build on a commitment to social justice and empowerment and strive for culturally anchored and long-lasting change for vulnerable groups. Among the seven core roles of CHWs are the provision of counseling and support services, serving as a mediator for communities with health and human services, and ensuring that individuals in communities receive necessary services (Spencer et al., 2010).The skills and techniques for carrying out these roles are characterized as informal or "basic." Bradford, Coleman, and Cunningham (2007) suggested that an adaptation to such role provisions could hold promise for a more influential impact on identifying and providing needed services, most notably in the area of reducing barriers to care and, by extension, addressing underlying factors that complicate both access and utilization of services by at-risk and affected groups. This modification or shift in the CHW practice is specifically articulated as move towards "system navigation." The fundamental difference here is a move from service provision itself to a focus on navigating a system and eliminating barriers to care. At its core, this shift in focus could be important in two critical areas: (1) identifying root barriers to care through the explorative and community-engaged process and (2) contributing to a more comprehensive care-coordination model, the latter being an important element in developing a long-term approach to meeting the needs of people living with HIV and AIDS who will need highly integrated and potentially lifelong intervention services (Vargas & Cunningham, 2006).

Although the vast skills of community care workers are well articulated in a body of literature spanning more than 20 years and in health areas as diverse as oral health, cancer, tobacco control, and accessing health coverage (Braithwaite, Treadwell, Ro & Braithwaite, 2006; Dohan & Schrag, 2005), several recurring problems have affected CHW services. The most consistent barriers have been the "lay" or nonprofessional nature of the CHW in a system dominated by professionals and the inability to establish stable mechanisms for covering the costs of CHW services (Spencer et al., 2010).

INTEGRATING SOCIAL WORK AND CHW MODELS OF CARE: SERVICE AND POLICY IMPLICATIONS

The CHW model is highly regarded as a promising mechanism for identifying and contributing to the amelioration of health inequities (Ingram, Sabo, Rothers, Wennerstrom, & de Zapien, 2008). Modifications in the model that would incorporate improvements identifying and confronting structural barriers to services access and utilization are regarded as important for meeting the growing complex needs of people and communities disparately affected by HIV and AIDS (Bradford et al., 2007). The shifting context of domestic HIV/AIDS with the introduction and pending implementation of the Obama administrations' NHAS provides a unique opportunity for social workers to reestablish and reinvigorate their roles as community-engaged leaders to reduce the impact of HIV and AIDS domestically. Blending the already compatible arenas of CHW and professional social work practice across the continuum of services from informal and basic contacts to highly integrated service delivery systems would appear to be an "easy reach." Social workers in many jurisdictions are recognized professionals in HIV and AIDS, providing reimbursable services that could readily incorporate CHWs' skills. CHWs already are highly engaged workers within the community context and could provide a much-needed cultural- and community-informed legitimacy to social workers. Social work educational pathways could be created for CHWs from community college through master's-level training. Rather than competing for a limited resource base, it would be prudent for CHWs and social workers to identify opportunities to join their efforts in a revitalized domestic H1V agenda.

REFERENCES

Bradford, J. B., Coleman, S., & Cunningham, W. (2007). HIV system navigation: An emerging model to improve HIV care access. AIDS Patient Care & STDs, 21(Suppl. 1), 49-58. doi: 10.1089/apc.2007.9987

Braithwaite, R. Treadwell, H., Ro, M., & Braithwaite, K. (2006). Community voices: Health care for the underserved. Journal of Health Care for the Poor and Underserved, 17(Suppl. 1), v-xi.

Dohan, D., & Schrag, D. (2005). Using navigators to improve care of underserved patients: Current practices and approaches. Cancer, 104, 848-855.

Ingram, M., Sabo, S., Rothers, J., Wennerstrom, A., & de Zapien, J. (2008). Community health workers and community advocacy: Addressing health disparities. Journal of Community Health, 33, 417-424.

Office of National AIDS Policy. (2010). National HIV/AIDS Strategy. http://www.whitehouse.gov/administration/eop/onap/nhas

Perez, L. M., & Martinez, J. (2008). Community health workers: Social justice and policy advocates for community health and well-being [Commentary]. American Journal of Public Health, 98, 11-14.

Spencer, M. S., Gunter, K. E., & Palmisano, G. (2010). Community health workers and their value to social work. Social Work, 55, 169-180.

Vargas, R., & Cunningham,W. (2006). Evolving trends in medical care--Coordination for patients with HIV and AIDS. Current HIV/AIDS Reports, 3(4), 149-153.

Wheeler, D. P. (2007). HIV and AIDS today: Where is social work going? [National Health Line]. Health & Social Work, 32, 155-157.

Darrell P. Wheeler, PhD, MPH, is associate professor and associate dean for Research and Community Partnerships, School of Social Work, Hunter College, City University of New York, 129 East 79th Street, New York, NY 10075; e-mail: dwheeler@hunter.cuny.edu.
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