Circle of Care: Beyond HIV Counseling and Testing

Brief communication 381 CIRCLE OF CARE: BEYOND HIV COUNSELING AND TESTING Overview Many HIV counseling and testing programs do not link both seropositive and seronegative individuals with comprehensive services after HTV testing. East Boston Neighborhood Health Center implements HIV counseling and testing in four programs: (1) a confidential program for existing clients; (2) an anonymous test site serving inner-city residents; (3) a mobile unit serving courts, methadone clinics, and substance abuse programs; and (4) a screening clinic for immigrants. This paper presents counseling and testing data from these programs for two periods. In addition, data on referrals for both seropositive and seronegative individuals from the anonymous test site and mobile unit are reported. Personalized referrals ensure that newly seropositive individuals are immediately engaged in comprehensive HIV care. Referrals for individuals with high-risk behaviors help maintain their HIV negative status as well as promote early HIV detection and intervention. In addition, referrals that extend to families and social networks complete the circle of care. Background The risk of HIV infection is particularly high among such groups as injecting drug users and their sex partners, sex workers and their partners, men who have sex with men but are not gay identified, and minority women. Although counseling and testing services are available in most communities to reach these high-risk groups,1,2 most programs do not link both seropositive and seronegative individuals with comprehensive health care services after HIV testing. For some (e.g., insured persons who have a primary care provider or persons with adequate financial, material, and social supports), these linkages may be unnecessary. However, disenfranchised populations may lack resources and be unable to advocate for themselves to obtain health care and social services. In addition, marginalized persons may be inhibited from accessing care because of past negative experiences with bureaucratic systems . The advantages of linking seropositive individuals to health care services include provision of treatment and prevention of new infection. The less obvious but equally important reasons for engaging seronegative individuals into care include ongoing opportunities for HIV education as well as establishing a safety net for early detection and intervention in the event that Received October 1,1999; revised April 1,2001; accepted June 6,2001. Journal ofHealth Care for the Poor and Underserved · Vol. 12, No. 4 · 2001 382 Circle of Care infection does occur. The purpose of this paper is twofold: (1) to report HIV counseling and testing data from four community-based programs at one inner-city health center and (2) to describe types of referrals from two of these programs to health and social services needed by seropositive and seronegative persons who are generally not engaged in care. HIV counseling and testing programs exist in many communities throughout the United States. The structure of these programs varies. Some programs focus only on counseling and testing, while others provide participants with an educational program on HIV prevention.3 Most of these programs have been housed in single locations or have focused on single populations.4"10 In some instances, counseling and testing programs have been taken to community settings to access hard-to-reach populations.3,11 The effectiveness of education , counseling, and testing programs in reducing risk behaviors for HIV infection has been documented.12'19 Two goals for these programs are clear. The ultimate goal is the prevention of HIV infection. Secondarily, when an HTv* diagnosis is made, persons living with HIV/ AIDS (PLWHIVs) are linked to HIV health care services. Understanding the needs of PLWHIVs and linking them with services are essential to promoting increased survival and a high level of wellness. The varying needs of PLWHTVs receiving care in different settings (e.g., home care, hospital, outpatient clinics, long-term care) have been compared.20 The independent effects of demographics and socioeconomic variables on unmet needs for HIV-related services have been examined .21 Solomon and colleagues reported on the use of health services in a cohort of intravenous drug users with known HfV-I serostatus.22 Case management models have been used to link PLWHIVs with health care and social services.23"29 Special programs have been established to link certain AIDS populations with services. For example, the...