Early in the epidemic, we realized that women presenting for care were very different from most of the men with HIV. For example, most of our patients were women of color and not “out” about their diagnosis. For them, the clinic simply did not work; coming to a clinic designed and staffed primarily by gay men reinforced their feelings of isolation and stigma and many women did not feel comfortable remaining engaged in care. For them to become healthy and empowered, WHP innovated a model of care that provides comprehensive female-focused health and social services to women, girls, and their families all under one roof. For over two decades, WHP has demonstrated the proven results of its care model through the excellent health of its patients as well as through pioneering research, publications, and leadership.
Recently, WHP has spearheaded a national campaign to raise the bar in what is considered effective care for people living with HIV. Until now, the goal of care has been to help patients effectively treat their HIV virus with antiretroviral medications. In reality, this is far from sufficient. Despite effectively treating their HIV, many of our patients remained depressed, addicted to drugs, isolated, living with abusive partners, and not working. Far too many were dying from preventable illnesses having nothing to do with their HIV. Our focus has been to raise the bar from a narrow focus on treating the virus with medications to a care model that leads to genuine health and empowerment. We are now the first HIV program in the country to fully adopt trauma-informed primary care as the most evidence-based approach to effectively address the key social determinant of most illness, death and disability in the United States.
WHP focuses its research on understanding and effectively addressing trauma – the key underlying cause of illness, death and disability among our patients and people across the country. Our research demonstrated that women and girls living with HIV have incredibly high rates of trauma. Trauma is defined as “an event, series of events, or set of circumstances [e.g., childhood and adult physical, sexual, and emotional abuse; neglect; loss; community violence; structural violence such as racism and homophobia] that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects.” Our research also found that unaddressed trauma leads to HIV medication failure and a host of other poor health outcomes. Most importantly, our research has demonstrated that pragmatic interventions that address trauma are highly effective at improving the health and wellbeing of our patients.
With evidence-based research and partnerships with other organizations, WHP developed a new model of care- trauma-informed primary care. WHP is committed to fully implementing this model in our clinic and serving as a national demonstration site and center for advocacy and dissemination of this model to clinics nationally, for people living with HIV and the far greater population of individuals who have suffered from trauma and violence.
The foundation of our health policy and national advocacy work has always been rooted in effectively addressing the needs of the patients we see in clinic. Through our research and experience in clinic, it became clear that the devastating health impacts of trauma were unrecognized and unaddressed throughout our health system. Through partnerships with leading community-based organizations, national foundations and federal agencies, WHP is working at the highest level to transform our health system from one that treats illnesses to one that more effectively heals individuals.
WHP co-led the first National Strategy Group on Trauma-informed Primary Care to define the core components of a response to trauma in our care system. WHP Director, Edward Machtinger, testified at the White House Federal Working Group on the Intersection of HIV/AIDS, VIolence Against Women and Girls, and Gender-related Health Disparities and was a keynote speaker at the White House for the release of its report. WHP and its partners successfully advocated to include a focus on trauma in the new 2015 National HIV/AIDS Strategy, the first time trauma was ever mentioned in the National Strategy. Currently, we are partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop best practices in trauma-informed primary care for all clinics across the country. In partnership with the Positive Women’s Network-USA, we are working with the Department of Health and Human Services (DHHS) to transform the entire Ryan White Federal Care system, serving 1.2 million individuals, into one that is trauma-informed.