As we enter the third decade of the AIDS epidemic, the global devastation caused by HIV continues unabated. Here, in the United States, access to new therapies, especially highly active antiretroviral therapy -- HAART -- has led to a decrease in AIDS death rates. However, HIV incidence rates and AIDS case rates are rising. Annually, HIV infects the same number of people today as it did twenty years ago. Despite the availability of HIV medications to keep people from developing AIDS, a combination of late HIV diagnoses, diminished access to appropriate health care, and poor medication adherence are causing increased numbers of individuals with AIDS. The burden of HIV illness and death is being increasingly disproportionately carried by the poor and marginalized. We can explain these discrepancies in developing nations, but we are pressed to do so in the United States, where we can afford equitable access to medications and health care. The Prevention and Access to Care and Treatment (PACT) project, a community-based project in inner city Boston, is committed to improving health outcomes for under-served individuals with HIV disease. PACT is a project of the Division of Global Health Equity (DGHE) at Brigham and Women's Hospital (BWH), and Partners In Health (PIH), a non-profit corporation whose mission is to provide a preferential option for the poor. Through health promotion and harm reduction activities, PACT community health promoters help disenfranchised HIV-positive and high-risk individuals of the Roxbury, Dorchester, and Mattapan areas attain better health and quality of life. In 2006, New York City officials asked PACT to help them bring the PACT model to HIV/AIDS patients there, and today, PACT’s successful intervention is benefiting patients at the Lincoln Hospital in the Bronx. The model has also been expanded to Miami, Florida’s Jackson Memorial Hospital. The PACT approach also holds significant promise for other chronic conditions like diabetes and heart disease that disproportionately impact poor and minority patients. In 2007, PACT began a major project with the Codman Square Health Center to bring the community health worker model of care to diabetes patients in Dorchester and other local communities.
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