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Jaén J, Frankel A, French A, Davison R, Munoz-Laboy M, Martinez O. Medical-Legal Partnerships: a promising approach for addressing health-harming legal needs among people with HIV. FRONTIERS IN SOCIOLOGY 2024; 9:1422783. [PMID: 39045387 PMCID: PMC11264305 DOI: 10.3389/fsoc.2024.1422783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024]
Abstract
Introduction People with HIV (PWH), particularly those at the intersection of sexual and gender identities, face enduring obstacles to accessing HIV care, including structural stigma, structural racism and discrimination, housing instability, and limited access to health insurance. To address these challenges, Medical-Legal Partnerships (MLPs) in HIV care offer an innovative approach that integrates medical and legal services. By targeting health-harming legal needs (HHLN), MLPs aim to enhance the HIV care continuum outcomes for PWH. Methods This study examines the benefits and challenges of MLPs within organizations serving PWH through the social-ecological model. MLP providers (n=111) identified organizational-level challenges such as funding limitations, resource integration issues, and staffing constraints. Results MLPs demonstrated numerous benefits, including patient impact and benefits, comprehensive service provision, enhanced staff support and capacity, and potential for policy influence. Discussion These results underscore the feasibility of MLPs while offering valuable insights into their efficacy and challenges, guiding the implementation of MLPs to address health-harming legal needs, including discrimination, and thereby improving HIV care outcomes.
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Affiliation(s)
- Julia Jaén
- Social and Behavioral Sciences, Temple University, Philadelphia, PA, United States
| | - Anne Frankel
- Social and Behavioral Sciences, Temple University, Philadelphia, PA, United States
| | - Ashley French
- College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Robin Davison
- College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Miguel Munoz-Laboy
- School of Social Work, Stony Brook University, New York, NY, United States
| | - Omar Martinez
- College of Medicine, University of Central Florida, Orlando, FL, United States
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Carter DJ, Rahmani A, Evans R, Stratigos A, Brown J. HIV-related Legal Needs, Demographic Change, and Trends in Australia since 1992: A Review of Legal Administrative Data. AIDS Behav 2024; 28:574-582. [PMID: 38085429 DOI: 10.1007/s10461-023-04245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 02/20/2024]
Abstract
An enabling legal environment is essential for an effective HIV response. Using legal administrative data from the HIV/AIDS Legal Centre (HALC), Australia's specialist HIV community legal service, this article characterizes the nature and trends in the legal issues and needs of those with HIV-related legal issues in New South Wales, Australia since 1992. At present, approximately 40% of all PLHIV living in NSW receive a legal service from HALC during the most recent five-year period. Clients received legal services relating to immigration law at a greatly increased rate (2010: 36%; 2019: 53%), discrimination matters decreased (2010: 17%; 2019: 5.9%), wills and estates remained steady (2010: 9%; 2019: 8.3%). Most clients identify as male (76.9%), homosexual (55%) and are aged between 35 and 49 years of age (34.6%). This demographic profile of clients changed over time, becoming younger and more likely to have been born overseas, and increasingly identifying as heterosexual.
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Affiliation(s)
- David J Carter
- Faculty of Law & Justice, University of New South Wales, Kensington, Australia.
| | - Adel Rahmani
- School of Mathematical and Physical Sciences, Faculty of Science, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Rhys Evans
- Doctoral Candidate, Faculty of Law, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Alexandra Stratigos
- Industry Fellow, Faculty of Law, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
- HIV/AIDS Legal Centre, 414 Elizabeth Street, Surry Hills, Australia
| | - James Brown
- School of Mathematical and Physical Sciences, Faculty of Science, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Alur R, Hall E, Smith MJ, Zakrison T, Loughran C, Cosey-Gay F, Kaufman EJ. What medical-legal partnerships can do for trauma patients and trauma care. J Trauma Acute Care Surg 2024; 96:340-345. [PMID: 38147579 DOI: 10.1097/ta.0000000000004167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
ABSTRACT Trauma patients are particularly vulnerable to the impact of preexisting social and legal determinants of health postinjury. Trauma patients have a wide range of legal needs, including housing, employment, debt, insurance coverage, and access to federal and state benefits. Legal support could provide vital assistance to address the social determinants of health for injured patients. Medical legal partnerships (MLPs) embed legal professionals within health care teams to improve health by addressing legal needs that affect health. Medical legal partnerships have a successful track record in oncology, human immunodeficiency virus/acquired immune deficiency syndrome, and pediatrics, but have been little used in trauma. We conducted a scoping review to describe the role of MLPs and their potential to improve health outcomes for patients with traumatic injuries. We found that MLPs use legal remedies to address a variety of social and structural conditions that could affect patient health across several patient populations, such as children with asthma and patients with cancer. Legal intervention can assist patients in obtaining stable and healthy housing, employment opportunities, debt relief, access to public benefits, and immigration assistance. Medical legal partnership structure varies across institutions. In some, MLP lawyers are employed directly by a health care institution. In others, MLPs function as partnerships between a health system and an external legal organization. Medical legal partnerships have been found to reduce hospital readmissions, increase treatment utilization by patients, decrease patient stress levels, and benefit health systems financially. This scoping review outlines the potential of MLPs to improve outcomes for injured patients. Establishing trauma-focused MLPs could be a feasible intervention for trauma centers around the country seeking to improve health outcomes and reduce disparities for injured patients.
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Affiliation(s)
- Rucha Alur
- From the Perelman School of Medicine (R.A.); Carey School of Law (R.A.), University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery (E.H.), Medstar Washington Hospital Center, Community Violence Intervention Program (M.J.S.), Washington, District of Columbia; Critical Trauma Research (T.Z.), University of Chicago Medicine; Legal Aid Chicago (C.L.); Violence Recovery Program (F.C.-G.), University of Chicago Medicine, Chicago, Illinois; and Traumatology, Surgical Critical Care, and Emergency Surgery (E.J.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Martinez O, Munoz-Laboy M, Davison R. Medical-legal partnerships: An integrated approach to advance health equity and improve health outcomes for people living with HIV. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:871101. [PMID: 36303611 PMCID: PMC9580720 DOI: 10.3389/frph.2022.871101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Medical Legal Partnerships (MLPs) offer a structural integrated intervention that could facilitate improvements in medical and psychosocial outcomes among people living with HIV (PLWH). Through legal aid, MLPs can ensure that patients are able to access HIV services in a culturally sensitive environment. We conducted organizational-level qualitative research rooted in grounded theory, consisting of key informant interviews with MLP providers (n = 19) and members of the Scientific Collaborative Board (SCB; n = 4), site visits to agencies with MLPs (n = 3), and meetings (n = 4) with members of the SCB. Four common themes were identified: (1) availability and accessibility of legal and social services support suggest improvements in health outcomes for PLWH; (2) observations and experiences reveal that MLPs have a positive impact on PLWH; (3) 3 intersecting continua of care exist within MLPs: HIV care continuum; legal continuum of care; and social services continuum; and (4) engagement in care through an MLP increases patient engagement and community participation. The MLP approach as a structural intervention has the potential to alleviate barriers to HIV/AIDS treatment and care and thus dramatically improve health outcomes among PLWH.
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Affiliation(s)
- Omar Martinez
- College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Miguel Munoz-Laboy
- School of Social Welfare, Stony Brook University, Stony Brook, NY, United States
| | - Robin Davison
- College of Medicine, University of Central Florida, Orlando, FL, United States
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McLoughlin GM, Martinez O. Dissemination and Implementation Science to Advance Health Equity: An Imperative for Systemic Change. COMMONHEALTH (PHILADELPHIA, PA.) 2022; 3:75-86. [PMID: 35811831 PMCID: PMC9262159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Innovations in public health research and evidence-based interventions targeting chronic and infectious diseases are only effective if they reach their target populations. Individuals from low socioeconomic background, racial and ethnic minorities, and sexual/gender minority communities are most susceptible to chronic diseases such as obesity and cancer, and infectious diseases such as HIV and COVID-19. These disparities are driven by social and structural conditions including stigma and discrimination, housing instability and food insecurity, among others. Accordingly, interventions that aim to improve population health must be targeted toward marginalized communities who are often systematically excluded from decision making processes. This article introduces dissemination and implementation science as a key opportunity to advance health equity through integrating measures and metrics that evaluate if an intervention is successful at improving health outcomes in marginalized populations. Implementation science also provides frameworks to help evaluate the key determinants to implementation success which can inform subsequent health outcomes. Examples of how researchers have engaged with community stakeholders are provided, along with strategies in which dissemination has gone beyond traditional practices. Finally, ways in which universities can build capacity for implementation science as a means to address health disparities are provided with the goal of improving the translation of research to practice.
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Affiliation(s)
- Gabriella M McLoughlin
- Department of Kinesiology, College of Public Health, Temple University
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis
| | - Omar Martinez
- School of Social Work, College of Public Health, Temple University
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Martinez O. A review of current strategies to improve HIV prevention and treatment in sexual and gender minority Latinx (SGML) communities. Expert Rev Anti Infect Ther 2021; 19:323-329. [PMID: 32902348 PMCID: PMC10718306 DOI: 10.1080/14787210.2020.1819790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The HIV epidemic continues to disproportionately impact sexual and gender minority Latinxs (SGML). Several syndemic conditions have been linked with HIV acquisition and transmission among SGML including immigration, discrimination, environmental racism, substance use, and mental health. AREAS COVERED We provide a summary of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum among SGML. We also discuss intervention approaches and opportunities that respond at the intersection of HIV and COVID-19 prevention and treatment. EXPERT OPINION There is a dire need for the combination of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum. Interventions and combination approaches should be driven by community-based participatory action research. The inclusion of community members in all stages of the research process can assure successful implementation of program activities and deliverables, including the provision of culturally and linguistically appropriate services. Given the current COVID-19 pandemic, which is disproportionately impacting individuals living with HIV and other comorbidities, the elderly, and under-resourced communities with a ferocity not seen in other communities, intervention approaches that respond at the intersection of HIV and COVID-19 prevention and treatment are also urgently needed.
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Affiliation(s)
- Omar Martinez
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
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Ries NM. Conceptualizing interprofessional working - when a lawyer joins the healthcare mix. J Interprof Care 2021; 35:953-962. [PMID: 33445987 DOI: 10.1080/13561820.2020.1856799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Research, policy and practice in the field of interprofessional collaboration have focused on how medical, nursing, allied health and social care practitioners work together to positively impact patient care. This paper extends conceptual thinking about interprofessional practice by focusing on lawyers as part of the interprofessional mix. This attention is prompted by medical-legal partnerships (MLPs), a service model by which lawyers join health care settings to assist patients with unmet, and often health-harming, legal needs. MLPs are present in around 450 hospitals and other health care sites across the United States and the model has spread to other countries, including Australia, the United Kingdom and Canada. However, enthusiasm for the MLP model is not yet matched by good evidence on how, when and for whom the model works. Interprofessional scholars contend that imprecise terminology and poor conceptualization of interprofessional arrangements hinder high-quality research and evaluation. In response to their critiques, this paper formulates a stepwise conceptual framework to guide the design, implementation and study of interprofessional arrangements that connect health, social care and legal practitioners. This framework draws on findings from national surveys of MLP initiatives in several countries and adapts several key conceptual frameworks that have been developed from systematic reviews of interprofessional working in primary health care. These conceptual frameworks are valuable because they promote clarity about different modes of interprofessional working and characterize the factors at macro (policy, funding), meso (organizational) and micro (practitioner, patient) levels that help or hinder professionals from different disciplines in working together. The paper considers factors at these three levels that require particular attention when lawyers join health care settings and proposes questions for future research in this emerging area.
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Affiliation(s)
- Nola M Ries
- Law
- Health
- Justice Research Centre, Faculty of Law, University of Technology Sydney, Broadway Australia
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