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

Thanks to a nationwide network of specialized, clinic-associated outpatient facilities and competent registered physicians, the quality of care for HIV-infected patients in Germany is high. Although basic HIV research is also well advanced in several centers, in contrast Germany's clinical HIV research is barely discemable 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 which could provide a basis for such clinical studies. The competence network HIV/AIDS aims to overcome this shortcoming by serving as a comprehensive, nationwide research alliance. The established patient cohort is linked to 13 projects. The infrastructure required for communications and data exchange will be based on a telematics platform. There will also be various service facilities established within the network, creating an organizational structure to promote the horizontal exchange of information between centers, as well as establish the vertical exchange of knowledge between physicians, patients, public health policy makers, and the general public.     

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.