Dec 6, 2011

Montgomery AIDS Outreach: Providing HIV/AIDS care in rural Alabama

Rural Alabama & the Access to Care Initiative

Headquartered at the Copeland Care Clinic in Montgomery County, Alabama, Montgomery AIDS Outreach serves over 1,200 patients living with HIV/AIDS. MAO coordinates its operations from the epicenter of the HIV/AIDS epidemic in Alabama, as Montgomery County exhibits the highest per capita rate of HIV infection in the state and one of the highest rates in the Southeastern United States. With the implementation of the Access to Care initiative, MAO hopes to amplify its reach as it collaborates with AIDS Action Coalition (AAC) in Huntsville, AL and Whatley Health Services (WHS) in Tuscaloosa, AL to provide access to HIV-specific care in 47 of Alabama’s 67 counties.

Ultimately, the Access to Care Initiative will bring infectious disease specialty care to rural Alabama and will elevate not only the consistency and access to care, but drastically affect the standard of care for rural Alabamians. Using the simple formula of: (1)  installing telemedicine equipment in rural clinics; and (2) staffing each clinic with an RN equipped to provide direct patient care and liaise, via video and diagnostic tools, with providers at permanent sites, MAO will eliminate the barrier, faced by rural patients, of long travel in light of scarce transportation resources and limited freedom to leave home, family and jobs.

To this point, Alabama’s specialty care has been overwhelmingly based around the state’s urban centers. The more specialized a doctor’s practice, the less likely he or she is to settle in a rural area. As indicated by the 2010 U.S. Census, 55 of Alabama’s 67 counties are considered “rural” and these account for approximately 46% of Alabama’s population. It is no surprise that 60 counties have federal designations as complete or partial shortage areas for primary care physicians, and that every county in the MAO service area is medically underserved.

The health care system in Alabama includes community health centers, small, local hospitals, federally qualified health centers, and HIV-specific clinics, but the state constantly struggles with a lack of providers. Compounding this problem, Alabama also lacks a public transportation system outside of Montgomery, Mobile, and Birmingham, and has an ultra-limited rural transportation system. As a result, it is overwhelmingly difficult to bring patients to care; however, telemedicine enables a doctor and patient to connect instantaneously, regardless of location.

Challenges & community partners

This ease of patient/provider interaction is essential in establishing the fundamental education and treatment services necessary to prevent the spread of HIV throughout rural Alabama. A July 2011 New England Journal of Medicine study reported that effective antiretroviral therapy decreases, by fully 96%, the likelihood of transmission of the HIV virus from a patient living with HIV/AIDS to an uninfected individual. Through the Access to Care initiative, MAO will bring both the full-force of its education resources, and the full-breadth of its treatment expertise to the forgotten corners of the state.

However, MAO faces significant challenges. Among the most daunting of these is the endemic reluctance, throughout Alabama, to acknowledge the disease itself; a factor that allows stigma and broad misconceptions to run rampant in the minds of the community at large. As a result, individuals living with HIV constantly fight discrimination, even at the hands of their friends and loved-ones.

The first of MAO’s rural satellite clinics is in Selma, located in Dallas County. To help overcome the many complex barriers, community partners play an invaluable role in patients’ lives by fostering trust and empowerment so they receive the care they deserve. MAO partner, Selma AIR (AIDS Information and Referral), provides transportation and referrals to individuals living with HIV. Just as community health workers serve to bridge the gap between patients and providers in rural Haiti, Selma AIR bridges the 64 mile distance between Selma and Montgomery.

Looking forward

As noted by Martin Luther King, Jr. in his 1963 speech on the steps of the Lincoln Memorial, the disenfranchised poor of Alabama waged the civil rights struggle to secure the “inalienable rights” of “Life, Liberty, and the Pursuit of Happiness”. This battle continues, and the “sunlit path of racial justice” remains to be paved.

Prior to my time at MAO, had I been discussing widespread poverty, staggering HIV infection rates, and/or patients’ inability to read or write, I might have reflected on case studies or stories I encountered when studying global health in college. That all changed, one morning, when I sat down to breakfast in Evanston, Illinois with physician Evan Lyon and heard the story of his work in Montgomery. He connected me with his friend Will Rutland, who immediately sent me the Human Rights Watch document entitled Rights at Risk: State Response to HIV in Mississippi. This 59-page document left me baffled and infuriated, realizing that even on a local level, the environment an individual is born into is a predominant determinant of the quality and length of that person’s life.

We are all capable of seeing problems; the true challenge is seeing solutions. Along with the global issues and the economic, social, and health-related disparities we are determined to remedy, I am confident that through the GlobeMed movement, in our generational moment, we can take a global approach to finding new, pragmatic solutions to the pervasive structural impediments that are slowly destroying our nation’s most vulnerable population.

Related Resources

MAO website
“Rights at Risk: State Response to HIV in Mississippi” by the Human Rights Watch

About the author

Pat Casey, former Co-President of GlobeMed at Truman State University, finished his Bachelor’s degree in Biology in 2011.  After spending a summer on the plains of northeast Missouri, Pat relocated to Alabama’s capital city of Montgomery, where the rate of HIV infection is 54.8/100,000 and one in every three persons is living on food stamps.

Today, Pat is volunteering as an intern at Montgomery AIDS Outreach (MAO), a non-profit organization located in the heart of Alabama’s “black belt”.  MAO operates 2 permanent clinics and 5 rural clinics, which, together, provide free health care and social services to those living with HIV/AIDS in 26 of Alabama’s 67 counties.  Through MAO’s new Access to Care initiative, supported by a match-funding grant from AIDS United and the Social Innovation Fund, Pat is helping Project Coordinator, Will Rutland to establish a framework for the use of telemedicine as a tool to address the ever-growing need for HIV/AIDS care in Alabama’s most rural places.

The Access to Care initiative aims to eliminate the barriers to care, faced by Alabama’s poor, rural population, resulting from long distance travel for HIV-specialty services.  In addition to his Access to Care work, Pat has also been busy publishing MAO’s newsletter, discussing MAO’s work through social media, and serving as MAO’s liaison for its new partner, GlobeMed at Princeton University.


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