POWER Program

POWER (Positive-Outcomes, Worthy, Educated, and Resilient) is a status-neutral job readiness program that provides access to post-secondary education and certification programs to individuals who have been marginalized and have faced socio-economic barriers. The programs links individuals who are at the most risk of contracting HIV, or not achieving (or maintaining) an undetectable viral load, to trade schools and college-level technical programs. The 2021 CDC HIV Surveillance Special Report[1] shows that 42% of transgender women were living with HIV and that number jumps to 62% when considering Black and African-American women, who are our primary trans demographic. The POWER program also provides resources for participants to increase access to technology, resume workshops, interview skills, conflict resolution support, and other tools necessary to secure employment once certified. The explicit purpose of this program is to address social determinants of health around economic stability and education access and quality. Programs that address social determinants are crucial to effective HIV service delivery. It is well researched and understood that economic instability causes barriers to getting tested, making it to appointments, paying for medications, and other medical and healthcare-related hardships. Positive Impact Health Centers is committed to creating avenues for individuals to gain skills to secure better paying jobs in professions with high job security and advancement opportunities.

Existing GED training program were not working as designed and were not meeting expected deliverables. After conducting community focus groups, evaluations of the GED program, and budget proposals; POWER was conceived and constructed. The program was launched in June 2023 in a piloted format in order to understand, on a granular level, the problem and need, successes, barriers, logistical challenges; and to gather participant feedback.

The pilot year of the program was divided into three stages: pre-implementation stage, implementation, and evaluation. The pre-implementation stage was from November 2022 to June 2023. The implementation phase and evaluation state are ongoing and co-occurring. The program is agency-funded and does not currently receive any outside funding which keeps the enrollment numbers low though the applications are high.

Our program is grounded in a hands-on, human-centered approach that prioritizes face-to-face learning in the classroom to train individuals as medical assistants. We rely on valuable data from focus groups within the trans community, ensuring that we address their specific healthcare needs and long-term goals. In addition, we integrate scientific principles, including the U=U concept (Undetectable = Untransmittable), to help participants understand that when someone with HIV is virally suppressed, they cannot transmit the virus. We recognize the critical role that stable employment, housing, and access to basic needs play in fostering independence, improving health outcomes, and supporting adherence to medications, which in turn contributes to better health and reduced HIV transmission.

It was decided that the initial pilot population would be individuals of trans-experience regardless of their HIV status. We chose this population because they are disproportionately affected by negative health outcomes caused by various social determinants of health. The 2021 CDC HIV Surveillance Special Report[1] shows that 42% of transgender women were living with HIV and that number jumps to 62% when considering Black and African-American women, who are our primary trans demographic. It is known that persons of trans experience see lower rates of viral suppression, very high awareness of PrEP but low uptake; and they are more likely to report missed doses of treatment and PrEP, missed appointments, and homelessness.

While this program initially focuses on equipping members of the trans community with the skills and certifications needed to enter high-demand professions, it simultaneously contributes to broader efforts in economic justice and social equity. The program plays a critical role in combating HIV by ensuring that those who are virally suppressed cannot transmit the virus, ultimately helping to curb the HIV epidemic in a meaningful, sustainable way.

PIHC has established itself as a model of gender-inclusive healthcare in the Atlanta community by ensuring that every program and service we offer is fully accessible and welcoming to all genders. Every staff member has undergone specialized training in gender inclusivity, and we actively implement this approach in all interactions and care delivery. We are committed to continually adjusting our programs to meet the specific needs and priorities of the trans community, ensuring they stay engaged in care. Early on, we recognized that hormone replacement therapy (HRT) was a critical priority for many of our trans clients, and as a result, we began offering HRT free of charge for those who remain engaged in care and maintain regular medical appointments. The impact of this service has been significant, with our viral suppression rates in this population increasing from 62% to 86% in just the first year of offering HRT. By consistently showing that we care about their unique needs and priorities, we have built a strong foundation of trust within the trans community in Atlanta. Our POWER program continues this commitment, reinforcing the message that "we care about you." As an agency, we serve over 11,000 individuals in medical care, and though the trans community makes up just 3% of those served, they are disproportionately vulnerable to HIV, unstable housing, and unstable employment. Through our comprehensive, inclusive care, we aim to address these disparities and improve the overall health and well-being of the trans community.

The agency already had an active communication channel with the trans-community through our Trans Life Care support groups and drop-in center for support. This is open to anyone regardless of status and regardless of if enrolled in care at the agency. The drop-in center is highly utilized by the Atlanta trans community.

The pilot year of the program was divided into three stages: pre-implementation stage, implementation, and evaluation. The pre-implementation stage was from November 2022 to June 2023. The agency had 7 people graduate in 2023, an additional 6 graduate in 2024, and 9 actively enrolled now. The agency has also hired 3 individuals in the program as medical assistants at the agency. We are committed to not only social justice and economic justice, but also helping graduates find inclusive employment after graduation.

Currently, 24 new individuals have applied to the program, and we are seeking funding up to keep up with the need.  The cost-per-student is approximately $7,500. For these individuals to gain certification as medical assistants, the overall costs include tuition, a laptop, unlimited weekly bus passes to classes, a monthly stipend for necessities like gas, scrubs, exam fees, and nutritional assistance when requested. 

The Trans Life program is highly responsive to the specific needs of the trans community, The decision to offer hormone replacement therapy free of charge for individuals engaged in care was based on direct feedback from the community, showing that the program listens and adjusts its services to prioritize what matters most to its members. This has had a clear, measurable impact, as evidenced by the significant increase in viral suppression rates.

The POWER program is innovative because it takes a HIV status-neutral, comprehensive approach to addressing health disparities by linking marginalized individuals, particularly those vulnerable to HIV or struggling to maintain an undetectable viral load, opportunities in education and workforce development. By providing access to certification programs, the program creates pathways for participants to build the skills needed for better-paying, stable jobs with long-term career potential and high demand positions.

The goals of the POWER program are centered around changing the lives of its participants, empowering them to achieve both personal and professional success while improving their overall health outcomes and stopping HIV transmission in Atlanta. 

1. 100% Graduation Rate for Enrollees - By offering tailored resources and support services, the program strives for full graduation rates.

2. 90% Employment Rate - After graduation, the POWER program is committed to connecting participants with employment opportunities. The program aims for a 90% employment rate for its graduates, ensuring they are able to secure and inclusive positions in supportive environments. 

3. 100% Viral Suppression - A critical goal of the program is to ensure that all participants with HIV achieve and maintain an undetectable viral load. By offering this program and hormone replacement therapy, we incentivize the participants to stay engaged in care and all other support services at our agency including mental health and recovery.

4. 100% Housing Stability - The program works to ensure that all participants have access to safe, stable housing before they enroll and then through employment after the program, they are able to maintain that housing on their own.

Five people work on this project, but there are 270 people that work for Positive Impact Health Centers and its 4 locations in metro Atlanta. Every program and service provided the agency is gender inclusive. We provide comprehensive care through medical services, emotional wellness and recovery programs, pharmacy services, support programs, prevention, screenings, immunizations, and testing services.

This will be the third year of the program. 7 people went through the program in 2023. In 2024, 19 people were enrolled and an additional 6 people graduated - with 9 still active in the program. 17 of the 19 currently enrolled in the program received wrap around services like PrEP, HIV treatment, and mental health counseling. 

As part of our initiative to train individuals of trans experience as medical assistants, we have a holistic approach that includes input from our Gender Inclusion Manager, a member of this community herself. She plays a vital role in overseeing our Trans Drop-In Center, which offers ongoing weekly support and resources. These efforts help to create a safe and empowering space where individuals can access training, mentorship, and guidance to pursue careers in healthcare. We encourage members of this community to apply for our program to enhance their employability and contributing to broader social and economic justice. This initiative not only strengthens the healthcare workforce but also promotes equity, offering a pathway to a sustainable livelihood and reducing systemic barriers.

The business model of the POWER program revolves around providing value to the trans community. he program offers a unique combination of healthcare services, including HIV treatment and hormone replacement therapy (HRT), as well as education and job readiness resources. The primary beneficiaries of the POWER program are individuals from the trans community. These individuals are often at higher risk for poor health outcomes, unstable housing, and unemployment, making them highly vulnerable to health and economic disparities. The program healthcare services, education and job programs, and social services. These services are delivered through a combination of in-house healthcare providers, community partnerships with local trade schools, universities, and employers, as well as dedicated case management and support staff. Participants in the POWER program have a variety of critical needs that the program solves consistent access to healthcare, medications, and treatment plans to maintain viral suppression and prevent transmission. The program addresses the high unemployment rates and economic instability in these communities by providing no barriers to a certification program. The program also helps with housing instability for those enrolled and engages them in other services at the agency including mental health and recovery. The program’s focus on integrating healthcare, education, and social support is what makes it particularly effective in delivering value to its key beneficiaries. By addressing the root causes of health disparities, the program not only improves outcomes for participants but also helps reduce broader community health risks, such as the transmission of HIV. 

PIHC has developed two key models for achieving long-term sustainability while providing comprehensive care. These models ensure that the agency delivers high-quality healthcare but also remains financially stable. PIHC prioritizes all patients have access to affordable insurance through the Affordable Care Act. The agency has placed patient navigators on-site who are dedicated to helping individuals enroll, making the process as seamless as possible. This model benefits patients by connecting them to both HIV care and primary care services, as well as specialists for other health conditions, improving overall health outcomes. In addition, the agency has created a patient assistance fund to help with out-of-pocket costs such as co-pays, co-insurance, and even premiums, ensuring that financial barriers do not prevent patients from accessing the care they need. By enrolling patients in insurance, PIHC is able to bill insurance for the services it provides, creating a mutually beneficial arrangement that helps sustain the organization while ensuring that patients remain engaged in their care.

Another innovative strategy for sustainability at PIHC is the establishment of two in-house pharmacies at two of its four locations. These pharmacies offer the dual benefit of providing patients with quicker access to their medications—often on the same day as their diagnosis—while also streamlining the process of obtaining medications. By filling prescriptions directly and billing insurance, PIHC helps ensure that patients receive the medications they need without delays. Additionally, the agency covers the cost of medications upfront and utilizes insurance billing to recover these costs. All revenue generated by the pharmacies is reinvested directly into patient care and financial assistance programs, further supporting the agency’s mission of providing comprehensive and affordable care to its community.

As a nonprofit, we have become sustainable, but programs like the POWER program are difficult without continued grant writing and requesting community donations. 

Our program aligns perfectly with this foundation's work, expanding our reach and impact within the most vulnerable populations—particularly those from the trans community and persons with HIV. The POWER program addresses the unique needs of those at high risk for HIV while also tackling larger issues like economic instability, unemployment, and housing insecurity.

We feel that our program is inspiring because it not only empowers individuals with the tools for economic and personal success but also offers a comprehensive support system that addresses health (individual and community), housing, and employment. Each participant is connected to the healthcare they need and want and offered resources for career advancement and housing stability.  

We are applying for funding to further strengthen and expand this vital program, knowing that it has the potential to create lasting impact not only on the individuals we serve but also on the broader community. The integration of education, employment, healthcare, and social services is a model that works, and with additional funding, we can reach even more individuals, provide more comprehensive support, and make a significant dent in the fight against HIV and the economic injustices faced by the trans community we serve. We can amplify its impact with this support.