Authors: Sarah Flicker et. al; Roy Cain and Sarah Todd, Cain & Todd; Raisa B. Deber et. al
This set of readings centre around treatment. An interesting theme that emerged almost immediately in all of the articles is how dramatically treatment and services for people with HIV/AIDS has changed in the years since the beginning of the epidemic. The Cain and Todd reading states explicitly that the introduction of highly active anti-retroviral therapy (HAART) drugs changed the landscape of AIDS services organization and the jobs of AIDS services workers. It went from being about palliative care and preparing for death, to dealing with how live with AIDS and the factors that may have lead to clients contracting the disease in the first place (e.g. intravenous drug use).
While none of the readings deal directly with black women, they are all based on studies conducted in Ontario. They create a clear picture of the current treatment landscape from the perspective of the people who work with clients who have HIV/AIDS. To be honest, it all seems somewhat bleak. The first Cain reading discusses how changes to legislation and funding has negatively impacted the quality and type of care that people with HIV/AIDS receive from social service organizations. While it highlights a number of important points, I found myself wondering what exactly were the policy changes that the workers were dealing with. The second one discusses how the introduction of HAART has also changed the way people with HIV/AIDS are treated.
The most interesting point that both Cain/Todd articles highlight is how the changes in the AIDS services landscape have impacted workers who perhaps entered the field because of a link to the community impacted by AIDS and are now dealing with people who are worlds apart from them. It is sad on both sides, for the new types of clients with HIV/AIDS—those dealing with poverty, addictions, abuse and other factors—and the workers who got into the field when many of their clients were gay males who were dying. Now the clients are different, need more support in terms of day-to-day help and rarely die. I couldn’t help but picture poor black women as I read about service workers who had trouble relating to their clients who needed housing and other help.
It is a strange and interesting set of circumstances. It is also very important that these issues have been brought to light by the studies because this disconnect and the challenges social service workers face play a huge role in the quality and type of care that people with HIV/AIDS (including black women) receive from AIDS service organizations. The studies point directly to a problem or challenge, the recognition of which may be the first step in coming up with new solutions and approaches to treatment and care.
At the same time it isn’t all bad news. The studies showed that there are still people working in AIDS service organizations who care and who are trying, despite numerous obstacles to help in the lives of people living with AIDS. They also point to the power of policy and advocacy.
The shift away from advocacy among service workers is probably a huge detriment to improving treatment. Without the people on the front lines (behind those with the disease) fighting for change in policy from governments rather than simply working around the obstacles erected by bureaucrats the chances of effectively combating HIV/AIDS here in Canada is severely compromised. There was a community element or incentive among the first AIDS service workers discussed in the readings that needs to be reignited I think in order to bring about positive change.
Despite the fact that these were all studies with small sample sizes, they were more effective to me than many of the theory based books I’ve read to date because they were based on interviews with real people. They show clearly the challenges and triumphs of dealing with HIV/AIDS and also, in a very human way, show that despite the challenges like funding and red tape, there is a way forward. It’s really a matter of taking that path. Somebody has to choose to challenge and change the status quo. I’m going to be reading reports by AIDS services organizations that focus on helping black women. I hope to find in them the seeds of people attempting to do just that.
This may be naïve of me, but for some reason in spite of it all the readings this week made a solution to the challenges of treating and supporting people with HIV/AIDS seem plausible and definitely possible.
My only comment is that the shift away from advocacy is central. It is connected to a dramatic shift in the funding of social services and a professionalization of ASOs. It is part of the new managerial context that shapes Canadian social services in general. The shift is not all bad, sometimes people talked about a discomfort having to see a community member for support, that they would prefer to speak to a professional. At the same time, that is a very different type of supportive relationship.
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