Case management alternatives for African-American women at high risk for HIV in Miami, Florida

Issues: An important finding of the Women Protecting Women (WPW) study, “Brief HIV/HCV/HBV Interventions for Drug-Using Women Sex Workers” (2000-2005), was that factors experienced by street-based, women sex workers – including homelessness, drug use, street life, and violent victimization -- contribute to HIV infection and other health problems. These are critical among African-American sex workers in Miami, given their low economic resources, impoverished environments, higher rates of HIV and barriers to seeking and accessing services. Description: WPW's peer-intervention success motivated a pilot study. A professional case manager worked with and trained two peer interventionists in the basics of case management. The pilot led to “Case Management Alternatives for African-American Women at High Risk for HIV” (NIDA-Health Disparities). Brief aims are to: 1) assess health service needs, service barriers, and HIV risks among 550 drug-involved, indigent, inner city African-American sex workers; 2) implement two strengths-based case management conditions, one featuring a professional/peer team; 3) evaluate conditions' effectiveness; 4) examine effects on services linkage, engagement, and HIV risk behavior reduction. Lessons: Exit interviews and focus groups reinforced the positive nature of the experience for the women. All emphasized that the team approach was compassionate and efficient, the process beneficial, and the peer facilitator was especially effective in breaking down barriers to service linkage. Recommendations: Test peer-involvement to increase linkages and engagement with drug abuse treatment, HIV-related care, and other health services. Develop an effective mechanism for addressing client health needs and service disparities to improve health status. First year experience will be presented.