Consider the Octopus: How HIV organizations can adapt to deliver the full spectrum of care in a changing health care environment

Occi, a reliable (uncharacteristically friendly) childhood friend.
Occi, the author’s reliable (uncharacteristically friendly) childhood friend.

Recently, I’ve had more than one dining companion say they refuse to eat octopus because octopuses are too smart. They may have a point – there was that octopus that successfully predicted the outcomes of World Cup matches. Maybe that doesn’t have anything to do with intelligence, but it got me thinking – octopuses are indeed pretty amazing. Masters of camouflage, they change colors, match patterns, and blend into their environment when threatened or to fit their “mood.” Octopuses can squeeze into the tiniest of spaces and will sacrifice an arm to escape a predator and regenerate the lost tentacle. They inject poison into their prey and emit clouds of black ink to obscure their escape from predators.

However, despite all of their astounding features, octopuses are far from invincible. They are solitary, anti-social creatures who view their own kind primarily as competition; they are vulnerable to large prey and other octopuses. Courtship is a brutal game of deception, and soon after hundreds of thousands of eggs hatch, the male and female die and only one or two of the hatchlings will make it to adulthood. It’s not exactly the spectacular life one may have imagined.

What in the world do octopuses have to do with HIV? Sometimes I think community-based organizations (CBOs) delivering HIV services are like octopuses: adaptable, flexible, savvy, resilient creatures who know their environment better than anyone. But they can also be threatened when working in isolation, moving too slowly, or not responding to their surroundings until it is too late.

While challenging, the last several years have been an incredibly exciting time to work in the HIV prevention and care arena. JSI is funded by the Centers for Disease Control and Prevention (CDC) as a capacity building assistance (CBA) provider to help CBOs implement High-Impact HIV Prevention programs. Our CBA@JSI team has been working with CBOs to help them identify their strengths and competitive advantages, all while building their capacity in other areas to meet the needs of their clients and respond to the ever-changing landscape.

In the U.S., we have a National HIV/AIDS Strategy, now updated to 2020, that drives everything we do. The Affordable Care Act has re-framed how we view health care, including comprehensive and preventive care for people living with HIV. Advances in science have led us to shift prevention efforts to ensure that people living with HIV are diagnosed, linked to care, retained in care, prescribed antiretroviral therapy, are adherent to their medications, and become virally suppressed. We now use surveillance data at the individual level to identify individuals who were never linked to care or who have fallen out of care, and get them into HIV medical care.

Much like our friend the octopus, CBOs have been trying to determine how they fit into this new environment and which cranny to squeeze themselves into. Sometimes someone else discovers the nook first, and they have to figure out if there is room for two, or if it is time to move on. Unlike the octopus however, a solitary existence is not an option in our current environment. Strategic partnerships and collaborations are the new vernacular. In this world that emphasizes biomedical interventions, care, and treatment, one organization likely cannot do it all. CBOs may not offer medical services, but they often provide supportive services that keep clients in care. And while clinic staff support individuals once they are in care, they typically do not have the capacity to reach out directly into the community and connect with the most vulnerable populations. The only way forward is working together.

The CBA@JSI team is committed to helping organizations navigate the new waters. We know there are still many roles to play – perhaps it’s just a matter of taking a cue from Mr. Octopus and trying on a new color palette.

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