Supportive Housing for the Chronically Homeless with HIV/AIDS

Abstract

This article examines an innovative supportive housing program for chronically homeless individuals with HIV/AIDS. A Better Place (ABP), a supportive housing program in New York City that provides housing and social services to HIV-positive individuals with multiple diagnoses (mental illness, mental retardation, developmental disability and/or chemical addictions), is offered as an example of an effective and economical model of service that aims to break the cycle of homelessness by providing comprehensive preventative care with positive long-term results. The structure and functioning of the program, along with two case summaries, are described in order to provide a service framework for practitioners engaged in this field of service.     

中英性病艾滋病防治合作项目的政策影响评估

目的了解艾滋病防治项目对政府的政策影响。方法对北京的20位艾滋病领域专家进行问卷调查和深入访谈。结果中英项目在同时期项目运作中效果最好、力度最大,对地方政策制定起到指导和先锋作用,同时给国家的政策决策者以循证。其中,对高危行为人群的干预活动政策影响力最大,而针对机会性感染的治疗和自愿检测措施影响力不足,效果不显著。结论中英项目在科学的指导原则下,采用以试点为基础的项目管理机制和“边实践、边总结”的做法,为国家艾滋病防治提供了很好的最佳实践经验。然而,项目经验的可持续发展问题受到挑战。     

Housing status and health care service utilization among low-income persons with HIV/AIDS

OBJECTIVE: To examine the impact of housing status on health service utilization patterns in low-income HIV-infected adults. DESIGN: A survey of 1,445 HIV-infected Medicaid recipients in New York State between April 1996 and March 1997. MAIN RESULTS: Six percent of study participants were homeless, 24.5% were “doubled-up,” and 69.5% were stably housed. Compared with the stably housed, doubled-up and homeless participants were less likely to be seeing a physician regularly (P=.0001), and if seeing a physician, they were likely to have been doing so for a significantly shorter time (P=.02). The homeless were also less likely than either stably housed or doubled-up individuals to see the same physician or group of physicians at each ambulatory visit (P=.007). In addition, a higher proportion of the homeless had made one or more hospital visits over the prior 3 months than the nonhomeless. After multivariate adjustment, doubled-up participants were found to make more emergency room visits, the homeless were less likely to be taking prophylaxis for Pneumocystis carinii pneumonia, and both the doubled-up and the homeless were shown to use slightly more outpatient care than the stably housed. CONCLUSION: Our study documents differences in health care utilization patterns across stably housed, doubled-up, and homeless HIV-infected persons after controlling for health insurance coverage. These differences, especially those pertaining to outpatient services, suggest that the unstably housed may be receiving less adequate health care than the stably housed, and hence may be more likely to experience adverse clinical outcomes. This research was supported by grant #NYS HRI 656-03-FED awarded to the AIDS Institute, New York State Department of Health (NYSDOH) by the Health Resources and Services Administration under the Special Projects of National Significance Program.     

Kompetenznetz HIV/AIDS

Germany's clinical HIV research efforts are underrepresented on an international level. This deficit is primarily due to a lack of clinical studies involving patients from across the country and the fact that no national patient cohort system exists in Germany which could provide a basis for such clinical studies. The competence network HIV/AIDS is filling this shortcoming by serving as a comprehensive, nationwide research alliance. The establishment of a patient cohort is linked to 20 projects. The success of this new structure is becoming visible.     

HIV/AIDS epidemiology

In this paper, Charles Todd comments that the report of Evan Wood and colleagues illustrates the dangers of taking a narrow medical view of the HIV/AIDS epidemic in Africa. It runs the risk of reversing the growing realization that the HIV/AIDS epidemic in southern Africa is a broad, social, cultural, political, and economic issue rather than a purely medical one. Todd raises the point that Wood and colleagues did not model the costs associated with the voluntary testing and counseling that should accompany a prophylaxis program. To this effect, a more helpful approach on meeting basic health needs and eradicating poverty would be to compare the impact of such levels of expenditure. It is also emphasized that the title of the paper of Wood and colleagues is misleading, implying that the focus of the modeling was sub-Saharan Africa as a whole, when it was in fact South Africa alone. Accordingly, the gross domestic product of South Africa per person is higher than that of nearly all other sub-Saharan African countries, and health expenditure is 10-20 times greater.