Persons challenged with HIV infection in Tennessee can receive a range of services paid for by a variety of sources. Their complex challenges are addressed with a philosophy of care that considers their overall wellness as a key to success.

For those without private healthcare insurance, two government programs, Medicare and/or TennCare ( Tennessee ’s version of Medicaid) often provide for medical care and medications. Two other major resources used are federal funds provided by the Ryan White CARE Act and the federal Housing Opportunities for People with AIDS (HOPWA.) Private donations and grants are also critical in meeting overall needs.

“Ryan White,” as it is commonly termed, is used to pay for medical care, dental care, medications, assistance with insurance premiums and co-pays. It also helps to fund other services like case management, emergency financial assistance, counseling, alcohol and drug addiction treatment, food/nutritional assistance, and transportation. It is important to note that the program was designed by Congress to be the payer of last resort.

HOPWA is designated for housing assistance, and, to a limited extent, it can also be used for emergency financial assistance. While some clients need very little assistance, others need virtually every service.

While the processes used to prioritize, allocate, and utilize all of the resources available is complex, understanding the impact of removing TennCare from the picture is fairly simple.

“The community regularly goes through the process of assessing and prioritizing the needs of people living with HIV/AIDS,” commented Hubbard. Obviously, the cost of ongoing medical care leads the list along with antiviral medications.

“Others on the priority list include things like case management and what we often refer to as “wrap-around” services,” he said.

When these needs are compared to the available resources, every attempt is made to utilize the Ryan White funds to fill the gaps.

“Ryan White funds will have to be shifted to those top priority items TennCare previously covered. The other services, despite having been proven to improve outcomes, will be reduced or eliminated,” noted Hubbard.

Although anti-viral medications are an obvious priority, persons living with HIV/AIDS often need other important medications to prevent opportunistic infections and deal with drug side effects. Elevated cholesterol levels, insulin sensitivity and diabetes, and chronic pain unresponsive to other therapies are all complications that require medication. Anxiety and depression often accompanies the disease, and overcoming their impact on adherence and general health means that treatment may be crucial to achieving and maintaining a good quality of life for patients with HIV/AIDS.

Mark Hubbard is a longtime HIV/AIDS activist in the Nashville/Middle Tennessee area. He can be reached at wharridot@hotmail.com.