Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

276 Abstracts WePeF6777-WePeF6781

XIV International AIDS Conference

WePeF6777I Laerning to care: Setting up a home for HIV
positive drug users and ex-prisoners
R. Rotthoff', P. Narayanan2. 1Project Manager, No.5, Jalan SG8/11, Taman Sri
Gombak, 68100 Batu Caves, Malaysia, Malaysia; 2Advisor, Kuala Lumpur,
Malaysia
Background: From 1992 to 1997, the two authors worked on HIV prevention
among street based drug users in Kuala Lumpur, Malaysia. In 1996, 50% of the
clients were found to be HIV+ from a small internal study. However services for
HIV positive drug users were non-existant. The organisation was under-resourced
to begin a care program for these drug users. For many years we witnessed street
based drug users falling ill soon after their diagnosis and we were picking up bodies from the streets almost every week. Hospitals were prejudiced against drug
users.
Methods: In 1998, the authors started a halfway home/hospice for drug users
with HIV and AIDS. The objective of this home, Pelangi Community Foundation,
is to offer drug users who are terminally ill, a place to die with dignity and proper
care. For drug users with HIV, it aims to provide a place to recuperate, learn new
skills and integrate back into society. It has limited capacity to provide large scale
care but thus far has been an important facility judging from the demand. Currently 5 drug users who are well provide care for 3 drug users who are terminally
ill.
Results: The setting up of this home was not difficult but the lessons we have
learned since is worth sharing. Do we allow clients to continue using drugs?
What about women client, can they stay with male clients (remembering this being a strict Muslim country)? What sort of income generating programs can we
implement? Which is better location - city or country? What are common client
complaints? What and how can we do better? These are some of the questions
that will be answered in this presentation.
Conclusion: The aim of this presentation is highlight a simple yet possible
method of care giving especially to marginalised community members. It is also
the hope of the authors that this presentation will open more discussion about
other interventions implemented elsewhere.
Presenting author: Rainer Rotthoff, No.5, Jalan SG8/1 1, Taman Sri Gombak,
68100 Batu Caves, Malaysia, Malaysia, Tel.: [phone], E-mail: rotthoff
@ hotmail.com
WePeF6778 Transitioning high risk HIV/AIDS patients from
inpatient hospital care to outpatient care
K. Wolff, J. Kostman, M. Duffalo, R. Maniglia, A. Norris, J. Gilmore. Penn
Community Infectious Diseases, Presbyterian Medical Center, Suite w250, 51 N.
39th Street, Phila., Pa 19104, United States
Issues: Despite improvements in treatments for HIV/AIDS that have increased
lifespan and decreased morbidity, many patients who are not receiving HIV care
continue to be hospitalized. These patients are often difficult to reach, due to
racial barriers, mistrust of the health care system, poverty, fear of the stigma of
AIDS, substance abuse, and mental health problems.
Description: Our hospital-based outpatient clinic has developed a program that
targets hospitalized patients who have no HIV provider, are newly diagnosed, or
have been lost to care. These patients are visited frequently in the hospital by a
nurse practitioner /social worker. Barriers to care, such as lack of insurance or
housing, substance abuse, and depression, are addressed in the hospital setting.
Patients develop a relationship with a provider before discharge, increasing the
probablility of follow-up care post-hospitalization. This year, the program identified
57 HIV+ hospitalized patients; 36 (63%) became patients in our clinic; 15 (26%)
were referred to other care providers; 6 (11%) remained lost to care. Patients who
initiate care with our clinic continue to see the nurse practitioner frequently to improve medication adherence and address other active issues. 18 patients have
successfully started and been maintained on HAART.
Lessons learned: Mental health issues and substance abuse are the most consistent barriers to outpatient HIV care, along with fear of disclosure of HIV status,
and lack of education about HIV disease or its prognosis. Patients may be more
likely to come into care if these issues can be addressed during hospitalization.
Future goals include a reduction in further hospitalizations, an increase in the
number of patients taking HAART, and potentially reduced HIV transmission.
Recommendations: Linking inpatient to outpatient care will target high-risk individuals alienated from the health care system for which outpatient care is most
important.
Presenting author: Kathleen Wolff, Presbyterian Medical Center, Suite w250, 51
N. 39th Street, Phila., Pa 19104, United States, Tel.: [phone], Fax: +1
215-243-4658, E-mail: [email protected]
WePeF6779 HIV medical case management as a link to care for
individuals recently released from prison

SA. Moreno1, S. Walker2, S. Mendive3, T Emanuele1, B. Blake4, J. Waelder1,
P. Keiser5, J. Sandoval4. 1Parkland Health & Hospital System, 1114 Pioneer
Drive, Dallas, Texas, 75224, United States; 2Dallas Urban League, Dallas,
United States; 3Bristol-Myers Squibb, Dallas, United States; I Texas/Oklahoma
AIDS Education & Training Center, Dallas, United States; 5U. T Southwestern
Medical Center, Dallas, United States
Issues: increasingly complex treatment regimens for HIV/AIDS require medical

case management, referrals, and treatment access for HIV+ individuals released
from prisons. Continuity of care between incarceration and first post-release medical visit has been problematic, with no direct link between state penal facilities
and community health services.
Description: Link-to-Care project establishes links between state prison system
and community-based organizations, relative to release of HIV+ minority individuals. Program model: 1) Continuity of Care case manager placed in prison unit;
2) linkage to case management program for offenders with mental impairments;
3) community-based medical case managers; 4) direct link to HIV primary care
at county hospital; 5) expedited enrollment in state drug assistance program; 6)
consumer involvement; 7) evaluation by regional AIDS education and training
program. Staffing: RN medical case manager at public hospital is outbased to
community agency, and.50 FTE MSW case manager within the prison system.
Purpose is to increase number of releasees linked to care, through case management, and enrolled in state drug assistance program. Project funded through
a state grant made to a community based minority agency, with public hospital
as major subcontractor. A pre-implementation survey conducted over a 1-month
period with public hospital HIV patients at intake (clinic caseload 4000) revealed
that 14 patients reported a recent incarceration. Of these, only 2 reported being
released with HIV medications, and 11 reported not receiving information on HIV
care. 11 of 14 reported "word on the street" as source of information about care.
Lessons learned: major gaps in information are reported by recently released
minority HIV+ inmates. Most get information from peers.
Recommendations: service linkages between penal institutions and community
providers are required to ensure transition between prison-based care and community based care.
Presenting author: Sylvia Moreno, 1114 Pioneer Drive, Dallas, Texas, 75224,
United States, Tel.: [phone], Fax: [phone], E-mail: samore
@parknet.pmh.org
WePeF6780 Live to tell: disclosure, support and collective
identification among PLWHA
J.W. Grierson, S. Misson, M.K. Pitts, M. Hurley, M.L. O'Brien, J. Willis. ARCSHS,
La Trobe University, ARCSHS, LaTrobe University, 215 Franklin Street,
Melbourne VIC 3000, Australia
Background: This paper examines the role that social networks and social identifications play in mediating the relationship between disclosure and social support
using quantitative and qualitative data collected through the Living with HIV research program.
Methodology: Data in this paper is from two studies of Australian PLWHA. Data
were collected from 789 PLWHA in the nationwide self complete HIV Futures 3
survey in 2001. Information was collected on: the patterns of disclosure of HIV
status in familial, social workplace and sexual contexts; on extent of social and
emotional support from a range of sources; and on the degree to which individuals experienced HIV positivity as a collective phenomenon. The HIV=Community?
study used semi structured interviews with 30 HIV positive gay men to explore notions of community and collectivity.
Results: Greater disclosure is generally related to greater social support. This
correlation holds within specific social categories (for example disclosing to family
and support received from family), but is also found in a generalised form (overall
levels of disclosure are related to overall levels of social support). This relationship is, however, mediated to a large extent by the degree to which individuals
feel connected to other HIV positive people. Greater HIV social identification or
connectedness results in an intensification of this relationship while greater individuation results in a weaker relationship.
Conclusions: Characteristics of social networks play an important role in the
manner in which personal and professional relationships are managed. HIV social identity (that is, collective identification with other PLWHA) acts as mediating
influence that may strengthen an individual's capacity to draw on multiple sources
of social support.
Presenting author: Jeffrey Grierson, ARCSHS, LaTrobe University, 215 Franklin
Street, Melbourne VIC 3000, Australia, Tel.: [phone], Fax: [phone]
5220, E-mail: [email protected]
WePeF6781 Consultation set together: an assistencial practice
to come close wisdom and persons
M. Deveza, A Pereira, R.C. Bernardes, C.A.O. Favoreto, F.A. Itikawa,
C.R. Marques, D.H.A. Lima. Universidade do Estado do Rio de Janeiro/ Hospital
Universitario Pedro Ernesto, Rio de Janeiro, Brazil
Issue: This is an activity to teach and assistance fulfilled by Medical Psychology
in the Integral Medicine Ambulatory of Universitary Hospital Pedro Ernesto-Rio
de Janeiro. Residents, medicine students and pos graduation students of Psychology, consult with teachers's support, general population that needs care and
health attention. We worked since 1995 when a specific attendance to people

with need an HIV testing or clinical retinue was organized. This HIV patient's attendance is carried out in a consultation set together by a clinical physician and
a psychologist, at welcoming environment, to offer an integral therapeutic with
information and emotional support.
Description: The consultation set together is an activity interprofessional and inter disciplinary used like a teaching strategy to drive at to take professionals's
abilities in your work place and to perfect the assistance job. It has the following