XVIII International AIDS Conference


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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 the US. 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 US.
Description: The State Healthcare Access Research Project (SHARP) is a collaboration between Harvard Law School, 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.
Lessons learned:
  • 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 long-term sustainability.
  • 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.
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.

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