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Howard Brown Health looks ahead to post-pandemic Chicago
by Matt Simonette

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As more Chicagoans get vaccinated against the COVID-19 infection, officials at Howard Brown Health (Howard Brown) are preparing their responses to a health landscape that will likely be much different from what it was before the pandemic.

"We were able to form a pretty urgent response to the pandemic, one that was informed by decades of responding to HIV," said Howard Brown President and CEO David Munar. "We're proud to have contributed to the epidemiology, COVID-testing, contact-tracing and now vaccinations and education."

Like many health providers, Howard Brown saw a surge of interest from patients eager to receive their COVID vaccinations earlier this year.

"A lot of vaccination efforts are going to be integrated into primary care, and it will be a struggle to persuade the half of the population who hasn't received one to accept it," Munar said. "But I think we're going to see more 'normalized' delivery of vaccines. … We're also going to start attending to the health needs in our health portfolios in a more robust way."

Munar speculated that a timeframe lasting as long as the pandemic itself—about 18-24 months—would likely be necessary to return healthcare service-delivery to "baseline 2019 levels."

He added, "We have evidence that a number of our patients who were on PrEP in 2019 are not on PrEP now. As for STIs, testing rates have declined and positivity rates have increased. The pandemic is directly affecting health equity by the disparities it's driving among some populations. It's also having a negative effect on good health. We're going to be recovering from COVID for a while, but the recovery from the crisis is also going to take a while to get back to where we were responding to HIV and [chronic conditions] like hypertension, diabetes, asthma and other chronic conditions."

Howard Brown officials have also noted an uptick in mental-health issues among its clientele, including anxiety, depression and suicidal ideation, thanks to the isolation and economic devastation many patients experienced.

"In a crisis such as the pandemic, nothing else can flourish," Munar said.

But the forced restructuring during the pandemic has at least raised possibilities for improvements to health care delivery in numerous realms. Telehealth visits, for example eased burdens on patients for whom making a trip to a doctor's office is difficult.

"[Telehealth] has allowed us to make care more convenient for those with cyber-access," Munar said. Howard Brown also mailed clients safer-sex kits, as well as kits to screen for HIV. Staff members were available via telehealth connections to walk clients through the HIV screening process.

But for patients lacking online resources, telehealth communication is a moot point and service-delivery to them remains an issue.

"The pace of change has really been a lot to assume," said Munar. "I know we're not alone, and a lot of organizations are going through that, but we've really been feeling it."

He also suspects that the pandemic will set back the state's Getting to Zero efforts, in which Howard Brown participates, in "very dramatic ways."

The Getting to Zero initiative would reduce new HIV transmissions in Illinois through a combination of strategies, among them easing PrEP and PEP access as well as access to treatments that reduce viral loads for persons living with HIV.

"A lot of people have not been back to the clinic who are living with HIV, so we think [the pandemic] has affected adherence," Munar said. "Treatment has been more difficult for some people, and it has probably been widening disparities."

Howard Brown Health was founded in 1974, ostensibly as a resource for education, testing and treatment for sexually transmitted diseases among gay men. That mission evolved dramatically as the organization began serving individuals with HIV/AIDS in the '80s. The organization became a Federally Qualified Health Center in 2014 and began expanding its geographic reach in subsequent years.

Even as the pandemic raged through much of 2020, Howard Brown proceeded with new projects, among them a standalone facility that will allow its Broadway Youth Center agency to have its own building for the first time (see sidebar) and a community center on the South Side for which state Rep. Lamont Robinson (D-Chicago) has been a prominent advocate. Munar said to expect more details on the South Side facility in the months ahead.

Munar said, "We've been working with Pride Action Tank on a needs assessment, which is complete, and the reports will soon be released. We've really mined the assessment, which was driven by responses from some 400 LGBTQ South Siders to determine priorities and programming. The rest of the year we will have a whole series of announcements."

The next steps will be determining a location and collaborating with other agencies to plan the building.

"We think that will be an opportunity to expand services directly and with partners," Munar said. "That project is still several years out, but we're going to be doing a lot of work on it this year."

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