A look inside Evergreen’s RAP program with Maria Cruz

These days, people living with HIV are able to live long, healthy lives. Medications are available that can lower the viral load (the amount of HIV in someone’s blood) of people living with HIV to the extent that the virus becomes undetectable.

People with an undetectable viral load aren’t able to transmit HIV to others, making their status U=U (undetectable = untransmissible). Treatment also prevents the virus from progressing to AIDS, letting people with HIV enjoy lives that can be as healthy and long as people without HIV.

Like many medications, the medications that manage the viral load of people living with HIV have to be taken regularly to be effective. People living with HIV usually have between 1 to 4 pills to keep track of each day for their treatment, in addition to any other medications they take.

While keeping up with that many medications could be difficult for anyone, people living with HIV are more likely to face other hardships that can push their treatment to the back burner. HIV disproportionately affects LGBTQ+ people, communities of color, people who use drugs, and financially vulnerable people – in other words, communities that face greater social and economic challenges throughout their lives and have been historically underserved by the health care industry.

That’s where Evergreen’s RAP (retention and adherence program) comes in. RAP supports people living with HIV who are experiencing challenges that get in the way of their treatment. The goal of the program is to take some of those challenges off the patient’s plate so they can focus on reaching an undetectable and untransmissible viral load.

The RAP program at Evergreen currently serves around 20 to 30 patients each week. The individuals who enroll in the program all have a viral load over 200 and face various obstacles that make it hard to keep up with their HIV treatment, like lack of transportation, homelessness, language barriers, stigma, substance use, or additional health issues.

While patients stay enrolled in the program for as long as they need support, the RAP team aims to help them reach an undetectable viral load within six months, and graduate the program after keeping their status undetectable for another six months.

Maria Cruz, director of treatment and prevention adherence at Evergreen, and the rest of the RAP team meet patients where they are when they enroll in the program, unconditionally. When a patient is referred to RAP or calls in to refer themself to the program, Maria connects them with both a Retention Specialist and a Patient Adherence Specialist who work together to meet the patient’s needs.

Retention Specialists are experts on all the resources available at Evergreen and in the community, and work to connect RAP patients with whatever services could help them. Patient Adherence Specialists are peers living with HIV who are there to offer support and talk things through.

Some days, Maria’s job looks like arranging transportation for patients to make their appointments and educating community members, patients and families to reduce stigma around HIV. Some days it looks like working with other departments within Evergreen to meet patients’ needs, like helping them get food with the Food Pantry team, find a safe place to live with the housing department, or connecting them with care for mental health or substance use.

Other days are less predictable – Maria’s team has spent a day helping a patient with a bedbug infestation get their home cleaned, buying them new clothes and furniture, and arranging community donations for ongoing support. The team has also spent a day helping a patient experiencing a mental health crisis who didn’t have anyone else to turn get safely to the hospital.

Maria says, “patients in the RAP program feel seen, supported and understood. Although the diagnosis of HIV is not a “death sentence,” the lack of education, added social determinants and stigma can make the diagnosis a difficult one to maneuver. Having a peer who can share their story with these individuals and a Retention Specialist educated on the many resources within Evergreen and the community can take some of the weight off the patient’s shoulders.”

If you’re currently in treatment for HIV and haven’t yet reached undetectable status, we’re here to help. Call 716-847-2441 and ask for RAP.