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PACT Health Promoter
Pillbox with medication.

PACT health worker meeting patient
A PACT health promoter meets with a patient in her home.


African American males have 7.7 times the AIDS rate as non-Hispanic white males.

American Indian/Alaska Native women have 2.5 times the AIDS rate as non-Hispanic white women.

Hispanic females have almost 5 times the AIDS rate as non-Hispanic white females.

Native Hawaiian / Pacific Islanders are twice as likely to be diagnosed with AIDS as the White population.

* The most recent statistics available from the U.S. Department of Health and Human Services as of October 2010

Though Boston boasts several of the world’s most renowned hospitals and medical training facilities, too many people living in the shadows of these institutions lack access to high-quality health care. The Prevention and Access to Care and Treatment (PACT) project is working to change that. PIH’s domestic project, established in 1998, strives to bring tailored, top-notch care to patients who are primarily people of color. Nearly all of the people served by PACT are African Americans and Latinos living in working-class or poor neighborhoods in Boston; many are unemployed, and most live below the poverty line.

These men and women are some of the sickest HIV/AIDS patients living in the Boston area, in large part because they are poor. Too often, poverty pushes a person into a cycle of economic marginalization and disease that is very difficult to escape. For example, more than 90 percent of our patients have experienced long-term unemployment as a result of HIV-related disability, language, or educational obstacles. 

Ninety-eight percent of PACT’s patients are enrolled in MassHealth, which is the state’s Medicaid program. Many speak little English, and have had limited access to education in both English and their native languages.

Many of the people in PACT’s team of community health workers (CHWs), live in the same neighborhoods with the people they serve. Because CHWs share many of the same experiences as their patients, they are uniquely qualified to provide sophisticated care, insight, and medicine. CHWs operate within the real contexts and belief systems of their patients, and are interested in empowering – not enabling – their patients. With proper training and support, CHWs can increase positive health outcomes, and reduce costs.

The three largest communities we serve – Dorchester, Roxbury, and Mattapan—are largely minority, and have born the brunt of the HIV pandemic in Boston. According to a June 2007 report from the Massachusetts Department of Public Health, HIV/AIDS ranked as the eight leading cause of death for both Hispanics and non-Hispanic Blacks, but only the twenty-ninth for whites. According to a public health commission report, North Dorchester bears the highest burden with six percent of the city’s total population and 16 percent of Boston’s reported HIV/AIDS cases. It is estimated that between 10 and 15 percent of the overall HIV population in Boston—somewhere between 700-800 patients—are eligible for PACT’s services.

Nationally, recent studies have found that African Americans and Latinos contract HIV at two to nearly eight times the rate of their white counterparts, and are much more likely to die from the disease.

The conditions that PACT has been confronting for more than fifteen years in Boston are indicative of a pervasive national problem: alarming racial and ethnic disparities in health outcomes in the US. Despite wider access to treatment for HIV, a combination of late HIV diagnoses, low access to health care, and poor medication adherence are resulting in growing numbers of patients with AIDS. In 2008, Blacks and Hispanics accounted for about 28 percent of the US population, but roughly 70 percent of those diagnosed with AIDS. 

In 2010, PACT joined with the Commonwealth Care Alliance and Network Health to work with10 percent of MassHealth’s patients; the organizations selected people suffering from chronic diseases, including diabetes, mental illness, substance abuse, hypertension and high blood pressure, whom they believed would be most aided by CHWs. The CHWs educate and counsel patients to maintain their medicine regimens, and keep regular appointments with their doctors. The program also helps patients avoid preventable emergencies, hospitalizations, and achieve better health and quality of life. These efforts continue to be ramped up to serve a larger spectrum of complex chronic disease patients.