Historical focus on biomedical solutions

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For many years, significant focus was on developing the life-saving medications needed to achieve viral suppression for those living with HIV. Once these therapies were developed, focus was on reducing debilitating side effects and pill burden. Now that these therapies exist—one pill/once a day with minimal to NO side effects—the HIV community and stakeholders are better able to identify and address other factors that prevent people living with HIV from getting their diagnosis, linking to care, and staying in care. Some stakeholders, including policy makers, are uncomfortable thinking beyond biomedical solutions. 

 

Public Health vs. Behavioral Health

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Historically, public health officials haven’t focused on behavioral health conditions and instead view these conditions as solely a “personal willpower” situation. Challenges still exist in terms of viewing behavioral health challenges through a more macro level, public health lens. 

 

Stigma around Mental Health and Substance Use

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Mental health and substance use have long been stigmatized conditions. As with HIV, stigma surrounding behavioral health can create debilitating barriers to receiving the care one needs to manage their conditions. 

 

Complex issue—Technical Challenge vs. Adaptive Challenge

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Technical challenges are those that can be solved by the knowledge of experts, whereas adaptive challenges are complex and ambiguous in nature, and may be volatile or unpredictable. Solutions to these types of challenges usually require people to learn new ways of doing things, change their attitudes, values and norms and adopt an experimental mind-set. In addition, there may be more than one way of approaching the issue and thus makes it more difficult to create step-by-step solutions. 

 

Capacity building offerings could be more robust

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Though Iowa has offered many high caliber trainings of the last three decades, the trainings could be more systematic, include providers and subrecipients, and ensure new staff are trained expeditiously.

 

High turnover in the workforce

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Turnover in positions that work with Iowans living with HIV can greatly impact these individuals—especially turnover in case managers, who build relationships and trust with those they serve.  When someone leaves the organization, Iowans living with HIV need to build relationships and trust with someone new.  This can be exhausting for them and create a disincentive for engaging in needed care.  

Ambiguity in Implementing Trauma Informed practices beyond training

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Although Iowa has done a lot around training in trauma informed principles, defining what a trauma informed agency or organization looks like is ambiguous (see technical vs. adaptive challenges).