For Ed Stellon, executive director of Heartland Health Outreach ( HHO ), engaging Chicagoans who have, or who are especially vulnerable to, HIV infection is about "more than putting signs on a train."
HHO is the primary healthcare provider for persons experiencing homelessness for the city, providing generalized medical, oral health and myriad other services for its clients. The larger Heartland Alliance organization has been around since 1888 and has historically worked with adults living on the margins.
"We've always taken the 'latest and greatest' when it comes to justice, housing, healthcare services, and then tried to tailor it to the most vulnerable populations," Stellon explained.
"We also take our 'show on the road' and partner with medical systems and go to shelters—about 36 different shelters—in the course of the month," Stellon said. "In addition to that, we have healthcare workers combing the streets, engaging people, especially the most vulnerable."
The goal is that a person experiencing homelessness will reach the same health outcomes as a person stably housed. "Our undetectable rate at HHO is 89 percent," Stellon noted. "…Right now, we're kind of outpacing the city. I'm pretty proud of that."
HHO case managers partner with other organizations to keep its clients on a continuum of care, he added.
"They remind them to take their meds and all kinds of 'extras' that provide day-to-day supports," Stellon said.
Those community partners are especially important in offering PrEP for HHO clients who might be more vulnerable to HIV infection; Stellon noted especially their work with Chicago House and HHO's sister organization, Heartland Human Care Services.
"[They] have recently gotten a grant to engage young men who have sex with men—and transgender folks—of color, especially on the South Side to really target transmission rates in Chicago," he said.
With this new program, advocates are employing what Stellon called "lived experience" to reach out to populations at risk; that means doing so through transgender persons or people already on PrEP who might already have relationships built up in the the targeted populations. Many of these folks will be reaching out through social media and hookup apps, and even in real-life gathering spots.
"The idea is to get tested and get treated," Stellon said. "If you are tested and are positive, come into HHO. Our focus is really unstably housed people, but more and more the lowest income people who are really struggling. If they are not [HIV-positive] but engaging in high-risk behaviors, we will counsel them on PrEP."
The new program is in in the very early stages, so Stellon looks forward to seeing the results. But he said that wraparound services that help persons experiencing homelessness will fill in vital gaps when it comes to eliminating new HIV/AIDS infections.
"Even without a cure, we could technically end HIV," he noted. "We could get everyone who is positive to find out their status and engage them in care and keep them in care, and with those around them considering and engaging in PrEP, we could actually end new infections. It's a lofty goal, but doable. What they're finding is, the group for whom this is not especially working well is homeless young people. When you're homeless, the last thing on your list of what's important is going to the doctor."
When people are stably housed, people are more likely to get and stay on anti-retroviral medications, he explained.
"That's why we use dynamic case managers to keep people connected," Stellon said. "We follow people. If we don't hear from you, we're going to find you and get you to come in."
