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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Anthony C. Tommasello, PhD, Office of Substance Abuse Studies, Univeristy of Maryland School of Pharmacy, 506 West Fayette Street, Century Building, Baltimore, MD 21201, 410 706 7513, atommase@rx.umaryland.edu, Jerry T. Lawler, PhD, Office of Substance Abuse Studies, University of Maryland School of Pharmacy, 506 West Fayette Street, Century Building, Baltimore, MD 21201, and Laura M. Gillis, MS, Health Care for the Homeless, 506 West Fayette Street, Century Building, Baltimore, MD 21201.
Homeless HIV infected persons with persistent mental illness and substance use disorders need services, are hard to reach, and difficult to enroll in treatment. Servicing this group is among the most difficult challenges of the AIDS epidemic. Outreach to shelters and soup kitchens fails to engage them. They disappoint expectations of traditional service providers because subsistence needs trump medical concerns. We report street-based outreach to homeless, HIV-positive persons with substance use disorders and/or mental illness and their response to treatment in an integrated system of care. This HRSA/SPNS project conducted street outreach using an interdisciplinary team: addictions counselor, nurse, and formerly homeless person. Service needs were assessed using standardized instruments. Outreach clients (OR) were interviewed and their responses compared to a matched sample of clients who walked in (WI) for services at control clinics in the community. Subjects gave consent before being interviewed. One-year follow-up was completed on 146 of 172 clients. About 65% of the sample reported an alcohol or drug problem. Cocaine and heroin were the drugs most frequently abused during 30 days before enrollment. About 60% of subjects reported needing substance abuse services at baseline. Over 12 months, there were substantial, statistically significant reductions in heroin and powder cocaine use during the last 6 months. Crack cocaine and marijuana use reductions were non-significant. Alcohol use fell among the ORs but not the WIs. Alcohol abuse fell non-significantly in both groups. Although ORs may not be as highly motivated as WIs, with help they can achieve the same improvements.
Learning Objectives:
Keywords: Chemical Dependence, Homelessness
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.