SHARPening our focus: improving access to care, building
community advocacy capacity, and forging broad coalitions in the Southern United States
R. Greenwald1,2, A. Rosenberg1,2
1Harvard Law School, Legal Services Center, Jamaica Plain, United States, 2Treatment Access Expansion Project, Boston, United States
Issues: Southern states have been hit hardest by the HIV epidemic in
Throughout the region, significant barriers to accessing healthcare exist.
While HIV-burdened nations like Botswana
boast antiretroviral treatment coverage of 80%, nearly 70% of people aware of
their HIV+ status in Arkansas
are not in care. This abstract describes a policy-based research initiative to
build sustainable grassroots advocacy infrastructure for HIV/AIDS in the southern
Description: The State Healthcare Access Research Project (SHARP) is a
collaboration between Harvard
the Treatment Access Expansion Project, and state-based partners, focused on
removing barriers to HIV care. SHARP
targets building advocacy capacity and facilitates sharing of effective
strategies among states. SHARP develops coalitions of stakeholders from inside
and outside the HIV community: providers, consumers, government, academics, and
business. Project staff and community partners identify successes, challenges,
and opportunities for improving healthcare access. One challenge identified throughout
the South is inadequate state funding for HIV/AIDS. With SHARP's efforts, $7.7
million of the Alabama
governor's budget was appropriated for HIV/AIDS, preventing 30% of medication
assistance beneficiaries from losing coverage.
Next steps: Endeavors in six southern states reveal that SHARP should
continue to facilitate strengths-based collaborations, using differences in
cultural norms and expectations creatively. SHARP must tap stakeholders from
outside the HIV/AIDS world, as barriers to care affect broader populations, and
diverse coalitions are more likely to succeed.
- Facilitation from neutral “outsiders” encourages diverse
stakeholder participation and catalyzes change. At the same time, emphasizing
local “ownership” of the process and product builds community capacity and
- Strengths-based approach is best?focus on state
accomplishments and existing resources to build infrastructure.
- Fostering interstate information sharing on access
challenges and successful approaches yields encouraging results.
- Maintaining regular communication with community partners
and stressing advocacy as a long-term, incremental process is critical.
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