Helping Community Members Confront Barriers to HIV Testing and Care

To ensure all people with undiagnosed HIV are aware of their status, one relatively straightforward solution is offering testing and linkage to appropriate HIV services when someone visits a doctor’s office or the emergency room. But what about people who don’t often go to the hospital or other traditional healthcare settings? In East Baton Rouge Parish, Louisiana, a new team of five community health workers has been hired through the Ending the HIV Epidemic initiative to take health and prevention services out into the community — offering information and education, asking questions about community members’ needs, and establishing critical linkages to HIV testing, treatment, and prevention.

A community health worker’s responsibilities are as diverse as the community itself. In a given week, the team could be distributing condoms and information about pre-exposure prophylaxis (PrEP), a daily pill that is 99% effective in preventing HIV transmission; screening individuals for HIV/hepatitis C (HCV)/syphilis; ensuring that someone recently screened for HIV, HCV, and syphilis is linked, as appropriate, to prevention services and follow-up care; and helping a new client with pressing health needs sign up for food assistance (and following up to offer HIV testing).

For team lead Isaac Gilliard, the work is personal. “When I found out I was HIV positive, I had no idea how to move forward,” he says. “It was a daily struggle. But one of the things that got me through was my housing case manager. She was the first person who made me realize that I could really live with this diagnosis.”

It’s important to Isaac and his team that they’re able to offer a range of services – including navigating the application processes for food assistance, Medicaid, and social security – as well as HIV testing, treatment, and prevention services. They say that providing this support has been integral to establishing a baseline of trust with community members, who may not feel ready to discuss their sexual health with an outsider.

“People sometimes take good health for granted, and I understand that — why would someone talk to me about HIV when they don’t have a job and can’t get food on the table? When I can offer help with those challenges, it builds a relationship where I can also help them see that getting and staying healthy is essential to meeting all their other priorities – and getting tested for HIV is one of the most important things people can do to take control of their health,” says Isaac.

This holistic approach is building countless connections between the health care system and people who would otherwise go without access to critical services they need. Many are already seeking HIV-related care: in the final quarter of 2019, the East Baton Rouge community health worker team conducted 179 HIV tests and referred 227 people for integrated screening for HIV, hepatitis C, and syphilis.

“I see people struggling to overcome the same barriers I had when I was first diagnosed with HIV that are easy for me to handle now,” Isaac says. “That shared experience – the fact that I have been in their shoes and can walk with them now – it creates trust, builds hope, and ultimately puts the people I work with on the path to living healthier lives, which is exactly what our program was designed to do.”