Incarceration histories of homeless veterans and progression through a national supported housing program

There is increasing concern that adults with a past history of incarceration are at particular disadvantage in exiting homelessness. Supported housing with case management has emerged as the leading service model for assisting homeless adults; however there has been limited examination of the success of adults with past history of incarceration in obtaining housing within this paradigm. Data were examined on 14,557 veterans who entered a national supported housing program for homeless veterans, the Housing and Urban Development-Veterans Affairs Supportive Housing program (HUD-VASH) during 2008 and 2009, to identify characteristics associated with a history of incarceration and to evaluate whether those with a history of incarceration are less likely to obtain housing and/or more likely to experience delays in the housing attainment process. Veterans who reported no past incarceration were compared with veterans with short incarceration histories (≤ 1 year) and those with long incarceration histories (>1 year). A majority of participants reported history of incarceration; 43 % reported short incarceration histories and 22 % reported long incarceration histories. After adjusting for baseline characteristics and site, history of incarceration did not appear to impede therapeutic alliance, progression through the housing process or obtaining housing. Within a national supported housing program, veterans with a history of incarceration were just as successful at obtaining housing in similar time frames when compared to veterans without any past incarceration. Supported housing programs, like HUD-VASH, appear to be able to overcome impediments faced by formerly incarcerated homeless veterans and therefore should be considered a a good model for housing assistance programs.

Support for condom availability and needle exchange programs among Massachusetts adults, 1997

This study was conducted to determine whether demographic factors, variables related to HIV risk status, or personal attitudes predicted public support for condom availability programs in high schools and needle exchange programs. Data for these analyses were collected from the 1997 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) among adults aged 18-64. Overall, 79% of Massachusetts adults aged 18-64 supported condom availability programs, and 60% supported needle exchange programs. Younger age was the strongest demographic predictor of support for condom availability, and higher socioeconomic status was the strongest predictor of support for needle exchange programs. Support for both programs was weakly associated with personal HIV risk status but strongly associated with positive attitudes toward teaching about HIV in schools and advising sexually active teens to use condoms. Our data suggest that there is broad-based public support for implementation of condom availability and needle exchange programs as tools for HIV prevention.

Survey of nonoccupational HIV postexposure prophylaxis in hospital emergency departments

BACKGROUND

Nonoccupational HIV postexposure prophylaxis (nPEP) is being used in community settings, but little is known about practice patterns. This study examined the status of nPEP in Massachusetts emergency departments (EDs), community sites where nPEP is most likely to be practiced.

METHODS

In June 1998, a mailed survey was sent to identified medical directors of the 78 hospital EDs statewide; 66 (85%) responded.

RESULTS

Overall, 52% reported having patient requests for nPEP within the prior year. 15% (10 of 66) had established written nPEP protocols; 33% (22 of 66) indicated their protocols were informal and not written. Twenty-five EDs could estimate the number of nPEP patients assessed; their mean estimate was 31 for the prior year (standard deviation [SD], 19.9) and 34% of the patients overall had nPEP recommended. Most (81%) of the hospitals with written or unwritten protocols recommended the use of three-drug antiretroviral regimens, which included two nucleoside analogues and a protease inhibitor; 41% approved more than one nPEP regimen.

CONCLUSIONS

A demand for nPEP is occurring in hospital EDs. The diversity of practice patterns suggests the need for evidence-based practice guidelines.