Amida Care Tackles HIV and Addiction Via Harm Reduction

Staying healthy while HIV-positive is a tall order, especially when you are also dealing with drug addiction. For the folks at Amida Care, harm reduction has proven to be a viable pathway from the pitfalls of addiction to a better, healthier life.

Amida Care is a medical health care plan for New Yorkers on Medicaid who are living with HIV/AIDS, and their children. They provide a Care Coordinator to assist with benefits and services, and pharmacy services. Through their Live Your Life Wellness Program, they also offer classes in healthy cooking and nutrition, African dance, Zumba, yoga, meditation, art therapy and more.

It was 1997 when Joann, a Brooklyn grandmother, was diagnosed with HIV. She was about 40 years old at the time, and was using drugs.

"I did initially take medication, but I wasn't really in treatment -- my addiction prevented me from taking my medication regularly, and I wasn't concerned about it at the time," she said. "I mostly thought HIV was going to be the end of me."

Joann said she eventually got into care, but relapsed, and continued to smoke crack cocaine for another 10 years. In 2011, she first heard about Amida Care, and decided to take care of her health. She began getting her labs done, but said she was still using drugs. When her mom passed away, she relapsed again.

"I never really adhered to my meds until 2013, when an Amida Care advocate came to my home," said Joann. "I had just come off a drug binge, and didn't even want to answer the door. But he talked to me and I agreed to set an appointment with a doctor. Since then, I've been with that same doctor. My T-cell count, which was less than 400 in 2013, is now 1003."

Joann never expected anyone to come knocking, except perhaps someone from the local Health Department, whom she had blown off in the past. But something about this outreach worker's approach felt different.

"They didn't pressure me; they were like, 'do you need this or that; what would you like to do?' It made me feel more comfortable," said Joann.

Lee Garr, Director of Integrated Care at New York's Amida Care, remembers the first time he saw Joann's name on his client list. She was suffering from severe depression, wasn't processing her feelings at all, and was filling the void with drugs. But Garr didn't rush to find a quick cure-all. He spent the first two or three visits just getting to know Joann, and figure out what she needed.

"As a clinician, I can't give a roadmap until I know the person," said Garr. "I need to establish trust, and then work up to other things."

The son of a father who dealt with addiction and mental illness, Garr grew up wanting to work with those who are disenfranchised and marginalized. But when he first heard about Amida Care, he was resistant to work for an insurance company.

"But when I found out how different Amida Care was, how they really believe that in order for people to have good health they have to look at the whole community as well as psychosocial issues like housing and workplace stability, I saw that, yes, they were an insurance plan, but also a community-based resource plan with outreach workers and health resources that was attractive to me," said Garr.

Garr was more interested in focusing on a client's abuse, and emotional and mental trauma, rather than just their substance use. His methods, though sometimes controversial, have proven effective at harm reduction. He cites a client who used crystal meth seven days a week, and how he worked with him to first take his HIV meds at the same time he took his crystal meth, to spur adherence. Later, when the man's HIV status became undetectable, he worked to taper down his drug use, eventually cutting it in half.

"For me, that is a success story," said Garr, "to take someone who is using drugs for 14 years and not taking their meds, with a T-cell count of 14, and get them to undetectable and using only three times a week. Too many times, people fall out of care for substance use or HIV clinical adherence because they're judged by doctors, social workers or case workers. You can't do that. You have to meet people where they are at."

At Amida Care, culturally competent counselor and workers connect with clients, and realize that no one knows what's best for someone's care but that person. It's important to Garr to acknowledge that they don't have all the answers, that recovery is a true partnership.

For Joann, finding a Care Coordinator prompted her to get back on her meds, and to kick her crack cocaine addiction. After she was clean for four years, a counselor asked her if she was interested in taking the entry exam to become an Amida Care Peer Counselor. She passed, and moved forward despite some reservations.

"When I first started, I felt I couldn't do this, that I was way too old," said Joann. "I'm 56 now, and I thought I was too dusty. But the counselor told me not to give up, and gave me the confidence I needed. Now, I love the work. It's not easy taking care of your health when you have an addiction, and homelessness can be a big part of it, too. You're more concerned where your lunch is coming from, not your next doctor's appointment."

Having a place to live and being stable is the first step toward being healthy, said Joann. HIV brought out other health issues like hypertension and diabetes, that if she were homeless, she never would have addressed. But Amida Care treated her whole health and wellness, and helped her get her life back.

"What Amida Care does is so important," said Joann. "They really go above and beyond. That's why I'm here now, doing outreach for them."

Garr feels the same way, saying that his clients keep returning because he is authentic with them. He lets them know if he needs more time to wrap his head around their case, and is honest about his feelings and emotions. He's not afraid to bump heads, because it shows they trust each other enough to disagree, and let the real recovery work happen. He'll even tell people if he believes another counselor would be a better fit.

For Garr, seeing Joann's situation veer in a decidedly healthier direction is why he does the work. He's grateful that she participated in their workforce training program, and can now help others who were once in her position.

"Now I think of Joann as my colleague, a person I call in to ask advice about cases," said Garr. "It makes me feel so lucky to have such a strong person on my team."

For Joann, the key to success was simply refusing to give up. She persevered, put herself first, and got her health back. It allowed her to be able to care for her granddaughter, who is now 15 -- an outcome that she said was rough, but absolutely worth it.

"I believe we all have a purpose for being here, and we need to stay strong," said Joann. "Had I given up, who knows where I would be? I'd probably not even be here. I am so grateful; I wish everyone could feel the way I feel."