My work with individuals who are impacted with HIV has spanned many years. In the early 1990s, at the beginning of my career as a community psychiatrist, I worked at Betak, a nursing home/hospice for people with AIDS that was in Northwest Center’s catchment area. It was a sad, sobering experience orienting me to the epidemic. The science, stigma and survival have come a long way since then.
In the early 2000s, I joined ActionAIDS in developing a small, specialized mental-health clinic, responding to the unique, unmet needs of clients who were misunderstood, mistreated or denied care. Over time, as education and advocacy efforts positively impacted mainstream mental-health care, the need for this effort waned.
In 2012, ActionAIDS partnered with Pathways to Housing PA to provide 20 housing and service slots as part of their “Housing First” program for folks with psychiatric disorders, chronic homelessness and HIV. An interesting finding is that, for these 20 individuals, the complicated issues of homelessness, poverty, substance use and mental illness usually trumped issues related to their HIV status. Most had a long-standing stable and valued rapport with their HIV-health provider that was an anchor of support. This successful partnership continues today.
In 2013, ActionAIDS reached out to Pathways to take part in an initiative focused on providing intensive case-management services to clients while they are incarcerated and upon discharge from Philadelphia county jails. The focus of the project, funded by AIDS United, is to identify and engage the most vulnerable clients who are at highest risk of being lost to care upon release from jail. Linking the clients to medical care, mental-health and drug and alcohol services, as well as having more frequent contact between the client and case manager, have enhanced this part of the Philadelphia Linkage Program by matching the complex needs of the clients with more effective and flexible services.
As I reflect on my involvement in working with individuals with HIV and mental-health issues compounded by having a history of incarceration, I have the optimistic sense that the glass may just be more than half-full. The glass isn’t full, especially with lots of barriers to adequate housing, complex and cumbersome rules for accessing substance-use treatment, and an over-burdened criminal-justice system. But even here, there is some light at the end of the tunnel. There are clearly changing public and political opinions about our culture of incarceration and retreat from the “War on Drugs.” The ActionAIDS Prison Linkage Program has built a solid working relationship with Philadelphia prison staff. And on the global and local levels, there is reason for optimism in controlling the spread of HIV.