Advancing HIV/AIDS Domestic Agenda: Social Work and Community Health Workers Unite

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. …