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HIV/AIDS ribbon
Incorporated in 1985, the AIDS Resource Center of Wisconsin began as a small local health organization established to confront the HIV pandemic. It had a staff of one. Today, 40 years later and known as Vivent Health, it is the headquarters of a nationwide network with 15 locations in four states. Offering its clients comprehensive medical, dental and mental health care as well as social and financial services, Vivent Health’s legacy represents its commitment to heath equity and social justice.
President and CEO Brandon Hill spoke to the current status of that legacy, HIV care, and the future. “Underscoring the history getting to where we are today is the success of a model now in use across the country. All the effort from lobbying to advocacy, the fundraising, walks and other events is now embodied in 6th Street. It is part of the local pride. It is one of the things that is not fully replaceable because a lot of what happened is unique.” he said.
That model is Vivent Health’s strategy of crafting varied resources like MAP (Milwaukee AIDS Project) with organizations in Madison and Green Bay into one HIV care system throughout the state. “It didn't happen anywhere else, no other state merged services,” Hill explained. “It significantly reduced HIV infection in Wisconsin. Today, health care collaboration is now the norm. But, in the 1980s, it was a novel concept that individual AIDS organizations be united into one standardized service. It alleviated competition for resources. Now, it would be one grant application rather than many at a time when each group competed for their piece of the pie. As much as any other effort, it is this care model that is a major part of Wisconsin’s success in the battle against HIV.”
Integrated Network
The state’s merged services became one integrated network under the AIDS Resource Center of Wisconsin. ARCW was then the only HIV specialized organization in the state. Without the distraction of competition, it could focus on patients’ outcomes. Programs like legal assistance and needle exchange that came from other projects were now part of the universal system. “As they consolidated, we reached more people, giving them access to services from across the state. The fundraising became interconnection of community through advocacy,” Hill said, recognizing early ARCW leaders like Doug Nelson and Paul Milakovich as the architects of the strategy to sustain and grow the network of HIV care we have today.
Moving on to HIV treatments, Hill reflected on the advances made since the organization’s founding. “In ARCW’s crucial first years, the great stride in treatment was the introduction of AZT in 1987. Still, even as AZT came on the scene, HIV was ultimately a terminal diagnosis. Today’s medicines with a regimen of one or two pills a day or an injection every two months reflects the advances science made since then. Its non-stop development has had a huge impact on the course of HIV. Today treatment management has reached 95% of viral suppression in three months and, eventually, a non-detectable level of infection. A non-detectable viral load means a zero possibility of transmission. It's as close to being free of HIV without an actual cure,” Hill said.
He noted some Vivent Health clients, now their 90s are living free of disease for decades. “Today, we are more worried about other health issues impacting our patients than of them dying of AIDS related causes,” he continued. Meanwhile, several long-acting treatments are the future of care and prevention. The current trajectory of research to that end is the relevant issue of therapy adherence. “The one pill a day regimen is a challenge regardless of the patient. We will see dosing less often within two years with all different possibilities that include self-injection and implants similar to other chronic care delivery devices,” Hill said.
Successful Legacy
Another aspect of the Vivant’s legacy of successful care and strategies is the funding. Hill cited the 1990 federal Ryan White HIV/AIDS Program and others that have made Vivent Health’s success possible. These programs provide funding as a payer of last resort, affording access to care regardless of economics. They also underwrote the continual study of the disease and its treatment.
“In the past, federal funding accelerated success. It was not a matter of constant upping of the intervention but of constant funding,” Hill said, noting the CDC (Centers for Disease Control) prevention, testing, and condom distribution programs along with NIH (National Institute of Health) funding studies and innovation were all part of the equation.
However, all of this is now in a state of suspension and uncertainty. “The CDC is now looking to eliminate prevention grants. It seems like a dismantling is happening just when we are on the precipice of success. We could end the HIV pandemic, but funding is essential. The concern is we could set ourselves back without those tools,” Hill said. The challenge, he explained, is figuring out whom lobbying should target. “The federal health system is very unclear at the moment. With its rearrangement, we don't know what the priorities are. Without the partnerships, we no longer know what the federal goals of the CDC are. It is different than first Trump administration when HIV was a priority. Right now, we don't know of any federal health priority. We are in the same boat with everyone else in health care.”
With both a history of decades-long success and some uncertainty about the future, Hill expressed optimism and a resolute commitment to the Vivent Health mission. “We've walked this path before when the organization was founded, and HIV wasn't a government priority. We’re going to rely on our community and keep caring for folks. It will keep up, moving forward. We have a strong foundation in our organization that created ARCW. We are going to continue to innovate and demonstrate how we can make a difference in the epidemic,” Hill concluded.
