Social service and case management needs of HIV-infected persons upon release from prison/jail

This study sought to identify social service needs of HIV-infected persons at the time of release from prison/jail and to describe their case management experiences after release from prison/jail. Sixteen men and women who were infected with HIV, each with a history of incarceration, participated in one of three focus group sessions. Study participants consisted of 11 men and five women. The majority of the participants were African-American (81%), single (50%), and currently unemployed (69%). Qualitative analysis of the focus group transcripts revealed a total of 483 comments regarding a need for social or health services. These comments were further grouped into 13 categories of services or service-related issues that represented the range of the responses. Although participants described positive experiences with specific case managers, their overall evaluation of case management was negative. Identified social services needs and the descriptions of their experiences with case management provides insight as to how case management services can be improved for this population.

Disclosure of HIV infection: how do women decide to tell?

This descriptive study explores the phenomenon of disclosure of HIV infection by women. Specifically, we examined women's level of disclosure to various groups and how these disclosure decisions are made. The sample consisted of 322 HIV-infected women residing in the southern US. Participants were predominantly African-American, single women of reproductive age with yearly incomes less than $10,000. Data were collected at the first interview of a longitudinal study of reproductive decision making. Findings showed that the majority of the women had disclosed to some sex partners, close family and friends, and health care professionals. However, for a group of women, disclosure of HIV infection is a difficult issue supporting the need for health education and counseling. Qualitative data were analyzed using content analysis and revealed three major categories describing how women make disclosure decisions: full disclosure, criteria for disclosure and emotional disclosure. Quantitative analysis revealed few demographic differences among women in the three disclosure categories. These findings provide insight that can assist those working with HIV-infected women in helping them decide not only to whom they disclose, but how best to disclose.

Factors influencing intent to get pregnant in HIV-infected women living in the southern USA

This descriptive study sought to identify factors that influence HIV-infected women's intent to get pregnant. Interviews were conducted with a convenience sample of n = 322 HIV-infected women at risk for pregnancy. Participants were predominantly African-American (84.4%), single (57.9%), and ranged in age from 17 to 48 years. Forty per cent (n = 128) of the women had been pregnant since becoming HIV-positive. Potential factors influencing intent to get pregnant that were examined included demographic characteristics, HIV-related factors and personal beliefs and attitudes. In simple logistic regression models, younger age, increased motivation for child bearing, decreased perceived threat of HIV, decreased HIV symptomatology, higher traditional gender role orientation, and greater avoidance coping were all associated with greater intent to get pregnant. Following a model selection procedure, motivation for child bearing (OR = 16.05, 95% CI 7.95, 30.41) and traditional sex roles (OR = 4.49, 95% CI 1.44, 13.55) were significantly associated with greater intent to get pregnant. Traditional gender role orientation and motivation for childbearing are significant factors in predicting intent to get pregnant among HIV-infected women. These factors, as well as other non HIV-related factors, need to be routinely assessed by health care providers in developing plans of care for HIV-infected women.

Preventing perinatal human immunodeficiency virus transmission: factors influencing women's intentions toward zidovudine therapy

BACKGROUND

Despite the benefits of zidovudine (ZDV) therapy in preventing perinatal transmission of the human immunodeficiency virus, HIV-infected women may not accept or adhere to therapy.

METHODS

This descriptive study identified factors in 322 HIV-infected women that influence intention to take ZDV if becoming pregnant and to give it to their newborns.

RESULTS

Logistic regression analysis showed the likelihood of taking ZDV in pregnancy and giving it to newborns was greater in women who believed ZDV slowed disease progression, ZDV was effective in preventing perinatal transmission, and their primary health care provider (PHCP) was positive about ZDV therapy. Additionally, women who were sexually active and had been pregnant since HIV diagnosis were more likely to intend to give ZDV to newborns.

CONCLUSIONS

Positive beliefs concerning ZDV effectiveness and the perception that their PHCP has a positive view of ZDV therapy during pregnancy are significant factors in women's ZDV-related decisions.

HIV-infected women's experiences and beliefs related to AZT therapy during pregnancy

To explore women's experiences and beliefs concerning zidovudine (AZT) therapy during pregnancy, short-answer and open-ended questions were asked of 322 human immunodeficiency virus (HIV)-infected women at increased risk for pregnancy. Specifically, we examined what women believed they had been told concerning AZT therapy during pregnancy by health care professionals and peers, experiences with taking AZT, how effective they believed AZT therapy to be, and if they would take AZT if they became pregnant. Women in the study were predominately African American (88%), single (79%), with a mean age of 32 years, and had annual incomes less than $10,000 (64%). Although 81.4% of the women had been told to take antiretrovirals, only 69.1% of the women were actually taking HIV-related medicines. Almost three-fourths of the women (70.8%) reported being told that taking AZT during pregnancy would reduce perinatal transmission. Women reported the most frequent reason for their stopping AZT was its side effects. When women who were not presently taking AZT were asked what would make them consider taking it, they most frequently said they would begin AZT if their health deteriorated or based on the advice of health care professionals. A small group of women said nothing would make them take AZT-type medications. More than one-half of the women said they felt AZT was effective in preventing perinatal HIV transmission. However, almost 20% of the women reported believing that their health care provider would not be positive about their taking AZT during pregnancy. Significant relationships were found between intent to take AZT if becoming pregnant and specific AZT-related beliefs and experiences.

Issues of women dually diagnosed with HIV infection and substance use problems in the Carolinas

A growing number of women are being dually diagnosed with HIV infection and substance use problems. Forty-two percent of all women diagnosed with AIDS have been infected through injection drug use. Many more women with HIV are exposed to nonintravenous drugs that potentially affect their quality of life and illness experience. This study sought to identify from the perspective of women factors that most influenced their ability to obtain treatment for their HIV infection and control their substance use. A focus group approach was used for data collection. Twenty-five HIV-infected women participated in one of four focus groups. Women were asked to identify and discuss their concerns and needs related to HIV/AIDS and substance use. Twenty-four women were African-American; one was white. All the women reside in South Carolina or North Carolina. Each focus group session was audiotaped and transcribed. Content analysis, following Krippendorff's (1980) methodology, was used to analyze the data. Five themes emerged: 1) AIDS as a life-altering event; 2) spirituality; 3) mental health issues; 4) barriers to health care services; and 5) environmental influences. It was concluded that the coexistence of HIV and substance abuse adds to the complexity of women's treatment needs. For these women, an HIV diagnosis can serve to alter their lives either positively or negatively. Dually diagnosed women have unique needs that require integration of physical and psychosocial interventions. These women may benefit from the services of psychiatric or mental health nurse practitioners who have the skills necessary to address the many psychosocial issues women face as well as provide physical treatment. Additionally, drug treatment services need to be expanded and made more comprehensive. Drug treatment programs need to be developed specifically for women, and these services need to be made accessible to poor women with substance abuse problems. Further, drug treatment programs need to provide comprehensive services that can appropriately integrate the treatment of HIV disease and substance abuse.

Hope and coping in HIV-infected African-American women of reproductive age

African-American women of reproductive age, particularly those living in the southern United States, represent a disproportionate number of women with HIV/AIDS. Often women who become infected with HIV in the South must cope not only with the disease, but with economic stresses and racial stigma, as well. Faced with these changes, these women experience increased distress and loss of hope. The purpose of this study was to examine levels of hope in a group of HIV-infected African-American women and to identify coping strategies that were associated with women maintaining a sense of hope for the future. A descriptive design was used to test the relationships between hope and coping strategies used by HIV-infected African-American women. Reported levels of hope were significantly lower for study participants than for women with breast cancer or for hospitalized adults with cancer who were receiving chemotherapy. Statistically significant positive relationships were observed between hope and the total coping score (r = .37, p = .009) hope and managing the illness (r = .47, p = .001) and between hope and spiritual activities (r = .40, p = .004). A statistically significant negative relationship was observed between hope and avoidance coping (r = -.35, p = .009).

Identifying HIV/AIDS research priorities for the next millennium: a Delphi study with nurses in AIDS care

The purpose of this study was to identify HIV/AIDS research priorities for the next millennium from the perspective of nurses in AIDS care. The study used a three-round Delphi technique, with study participants (the panel of experts) selected from the membership of the Association of Nurses in AIDS Care. In the first round of the Delphi study, 317 nurses identified more than 2,000 topics they viewed as important for overall HIV/AIDS research and for HIV/AIDS nursing research. Using qualitative analysis, 12 priority topics were generated in the overall research category and 12 priority topics in the nursing research category. In Round II of the Delphi survey, study participants ranked the 12 topics in categories (overall and nursing research priorities) identified in Round I. Finally, in Round III, the top five priority topics from Round II were prioritized in each category. The overall HIV/AIDS research topics identified were (a) HIV community-level education and prevention; (b) development of more tolerable drugs; (c) HIV prevention focusing on individual or specific group behavior; (d) vaccine development; and (e) development of new and more effective drugs. The HIV/AIDS nursing research priorities identified were (a) symptom management; (b) community-level HIV education and prevention; (c) quality of life issues in chronic HIV disease; (d) HIV prevention focusing on individual or specific group behavior; and (e) research related to adherence to drug therapy.

Levels of hope in HIV-infected African-American women of reproductive age

HIV disease continues to grow at a staggering rate among women, with women of color becoming the group most frequently affected. Previous research has supported hope as an important factor associated with better health, quality of life, recovery from illness, and increased survival in life threatening illnesses such as HIV disease. The purpose of this study was to describe levels of hope in HIV-infected, African-American women, and to examine the relationships among hope and the women's reported symptoms, stage of illness, and perceived relationship with her primary health care provider (PHCP). A descriptive, quantitative design was used. The sample consisted of 49 African-American women 18 to 45 years of age. Face-to-face structured interviews were conducted. Hope was measured using the Herth Hope Scale, and the quality of the relationship with one's PHCP was measured using the Relationship with the PHCP Scale. The level of hope in these HIV-infected women was lower than women with breast cancer and hospitalized adults with cancer. No significant differences were found in level of hope related to relationship status, income, stage of illness, or if a woman had or did not have children. Hope was positively associated with a more positive relationship with the PHCP (r = .33, P = .02). This finding underscores the importance of the quality of the PHCP's relationship with their clients.

Perceived HIV-related sexual risks and prevention practices of African American women in the southeastern United States

African American women in the southeastern United States constitute the fastest growing segment of those infected with the human immunodeficiency virus (HIV). Little data exist about the relationships between HIV infection risks and preventive practices. In this article, we describe a focus group investigation of how HIV-related sexual risks are perceived by 19 heterosexual African American women, ages 18 to 44. Data were analyzed and interpreted using content analysis, where key ideas, words, and phrases were grouped based on their relation to the purpose of the study. Four themes were revealed: "a man will be a man," inconsistent and/or no condom use, safe relationships, and racism and discrimination. Perceived safety within relationships mediated both perceptions of HIV-related risks and sexual practices. In light of beliefs about the riskiness of sex with high-risk partners, fear of HIV, and the importance of self love in minimizing HIV infection risks, the women continued to practice unsafe sexual behaviors. Results indicate that women perceive themselves as victims in society and that this perception limits their propensity to take action to protect themselves from HIV. Successful HIV infection prevention interventions need to address negative social and economic factors that define the context of many women's lives.

Health care providers' influence on HIV-infected women's beliefs and intentions related to AZT therapy

This study examined how women's relationship with their primary health care provider (PHP) and their perceptions about how effective their PHPs believe zidovudine (AZT) to be in decreasing perinatal transmission related to women's AZT beliefs and intentions. It used a cross-sectional design to collect data from 59 HIV-infected African American women. Almost half the women (45%) had given birth since HIV diagnosis. Most of the babies born to HIV-infected mothers (87%) were seronegative. Data analysis with Pearson's r indicated that the quality of the women's relationship with their PHP was positively correlated to how important the PHP would be in decision making related to AZT therapy. Significant positive correlation was observed between women's perceptions about how effective their PHPs believed AZT to be in decreasing perinatal HIV transmission and the women's own beliefs about AZT, their intent to take AZT if pregnant, and intent to give AZT to a newborn.

The care of women with AIDS: special needs and considerations

The growing number of women being diagnosed with HIV/AIDS mandates the need to focus attention on the special needs of this population. Although women have many of the same devastating physical manifestations of HIV infection as men do, they face unique psychological and social issues that influence their ability to respond to their disease in the same ways. Women with HIV/AIDS are disproportionally poor or minority women who lack resources to maintain their health. It is impossible to address HIV infection in women without considering such factors as poverty, discrimination, and gender role expectations. This article uses a biopsychosocial framework to discuss a range of specific issues affecting the health and well-being of women with HIV/AIDS.

HIV-infected women's decisions to take antiretrovirals

Despite the potential benefits of antiretrovirals, HIV-infected women may not be accepting or adhering to recommended drug therapies. To help women make informed decisions surrounding antiretroviral therapy, health care professionals need insight into how HIV-infected women decide to take or not to take antiretroviral drugs. The purpose of this study was to describe the influences affecting decisions made by women in the southern United States to accept and adhere to antiretroviral therapy. Focus group data with subsequent dimensional analysis were used to discover themes surrounding antiretroviral decisions among 22 women in two predominantly rural, southeastern states. The focus groups included some women who were currently taking antiretrovirals, some who had taken them in the past, and some who had never taken them. The analyses revealed four overarching themes that influenced women's decisions regarding antiretrovirals: health professionals, beliefs about antiretrovirals, side effects, and attitudes of peers and family.

Relationships among HIV risk beliefs, attitudes, and behaviors in sexually active, seronegative gay men

Safer-sex guidelines established during the early days of the HIV/AIDS epidemic have undergone very little revision despite some controversy. Although these guidelines have been widely disseminated in the gay community, many gay men continue to engage in behaviors that are believed to put them at high risk for transmission of HIV. This suggests either that they have not accepted safer-sex guidelines as accurate or that other factors override personal implementation of the guidelines. The study examined seronegative gay men's beliefs about the accuracy of safer sex guidelines and the men's participation in behaviors risky for transmitting HIV. The greatest disagreement between the men's beliefs and behaviors centered on the risk of oral intercourse; this suggests a need for clarification of the safer sex message about this behavior. The findings of this study support the need to reformulate safer-sex guidelines. When unprotected oral and anal sex are classified at the same level of risk, those who engage in unprotected oral sex may proceed to unprotected anal sex with less reservation.

Group sex in gay men: its meaning and HIV prevention implications

HIV/AIDS continues to pose a serious health hazard for gay men. Large numbers of men continue to become HIV infected each year, despite access to knowledge concerning how HIV is transmitted. Although gay men changed their sexual practices early in the epidemic, there is growing concern that there is a resurgence of risky sexual activities occurring in this group. Of particular concern is the resurgence of group sex activities. The purpose of this study was to explore the experiences of group sex in gay men to gain insight into the meaning of group sex to these men, the context in which it occurs, and men's views of how group sexual encounters relate to HIV transmission. The study used a qualitative approach to data collection. Ten self-identified gay men who reported engaging in group sex activities were interviewed concerning their experiences. Men reported that the most likely place for them to engage in group sex activities was in sex clubs, and a majority of their discussions centered on these clubs. Study data were analyzed using content analysis. Two overall categories of responses emerged from men's descriptions of their group sex experience: sexual desire and HIV/STD risk behaviors. Four themes--access to sex, sexual excitement or stimulation, sexual options, and control and sexual freedom--comprised the category of Sexual Desire. The themes identified within the category of HIV/STD risk behaviors included reframing risk, rejection of safer sex, and alcohol and drug use. The findings of the study suggest that sex in group settings such as sex clubs is a reality that must be addressed by HIV prevention efforts. Additionally, results indicate that current HIV prevention messages are being rejected by many gay men and need to be reevaluated for relevance two decades into the HIV/AIDS epidemic.

Case management at what expense? A case study of the emotional costs of case management

Case management, which has its historical roots in community and public health, seeks to coordinate care, decrease costs, and promote access to appropriate levels of service. The case management system in this case study underscores the potential negative outcomes that can result from ignoring the holistic approach represented by an implemented case management system as a cost control mechanism. These negative outcomes not only include those expenditures of resources usually included when describing costs of care, but include those emotional costs of the system, patient, and care managers. Several needed system changes are identified and recommendations provided.

Restructuring life to face the future: the perspective of men after a positive response to protease inhibitor therapy

This article describes a qualitative study that explores the psychosocial changes and care delivery issues experienced by men with AIDS who were facing end-stage disease but then had dramatic physical improvement as a result of protease inhibitor therapy. In-depth interviews were conducted with 11 men with HIV/AIDS drawn from a community-based AIDS service organization in a large metropolitan area in the Southeast. Using Collaizi's model of content analysis, three broad categories, protease inhibitors as a reprieve, changed roles and relationships, and need for advocacy and support, emerged from the data. From the three broad categories, seven more specific themes were identified: guarded optimism, buying time, change in relationships, work versus disability, access to medications, access to HIV/AIDS competent health care, and focused support services. Collectively, the phenomenon resulting from these men's experiences and concerns can be described as efforts to restructure life to face a future they did not expect. These findings support the need for developing formal, structured interventions to help persons living with AIDS (PLWA) to restructure their lives as new antiretroviral therapies promote improvements in health.

Quality of life in HIV-infected women in the south-eastern United States

The purpose of this study was to evaluate the relative importance of social (social support, material resources, disclosure, and family functioning) and psychological factors (stigma, emotional distress, intrusion, avoidance, and fatalism) as predictors of the quality of life of women infected with HIV. The cross-sectional data were drawn from interviews of a sample of 264 women recruited from 8 HIV/AIDS treatment sites in a south-eastern state. Variance in quality of life variables, included limited daily functioning, general anxiety, and HIV symptoms was analyzed using ANOVA, correlations, and hierarchical multiple regression analysis. Limited daily functioning was predicted by stigma, fatalism, employment status, and stage of disease (R2 = 0.179). General anxiety was predicted by emotional distress, intrusion, and marital status (R2 = 0.503). Reported HIV symptoms were predicted by material resources, disclosure, intrusion, age, employment status, and race (R2 = 0.294). The results of this study support that social and, particularly, psychological factors are important in their influence on quality of life in women with HIV infection and suggest the need for interventions which address such factors.

Resources, stigma, and patterns of disclosure in rural women with HIV infection

A growing number of cases of HIV infection are being diagnosed in rural communities especially among women. Although HIV-specific education and care delivery programs have been focused on rural areas in recent years, limited data are available on the impact of such initiatives on the lives of women with HIV infection. The purpose of this study was to examine characteristics of women with HIV disease living in rural communities. The study used a cross-sectional sample of rural women in Georgia. Data analysis indicated that although a majority of the women reported adequate resources, there was a group of women for whom resources for basic needs were not always adequate. Additionally, women with HIV who had not progressed to AIDS had greater difficulty in obtaining a number of resources. Almost half of the women felt stigmatized due to having HIV. Yet, a high percentage of these women had disclosed their HIV status to health care workers, sexual partners, and family. Study results provide insight into the needs of HIV-infected rural women from their perspective. This information can be important to nurses working in public health and community settings as they face the challenge of developing effective health care services for this population.

A case management curricular model. The challenge for nursing education

Preparing students for practice in a managed care system requires restructuring of the nursing curriculum. The authors describe a case management curricular model as a framework for baccalaureate education. Processes used for curricular redesign and recommendations for knowledge and skills expected of baccalaureate program graduates are included. Examples of expected student case management performance behaviors and evaluation criteria are provided.

Decisions to have a baby by HIV-infected women

As the epidemiologic picture of HIV changes to include increased numbers of women of childbearing age, particularly those of African American heritage and those from rural southern cultures, those who provide services to these women need to understand the processes used by HIV-infected women to make reproductive decisions. Focus-group data with subsequent content analysis were used to discover themes surrounding pregnancy decisions among 22 women in two predominantly rural southeastern states. The results both validated and amplified previous findings and added new perspectives. The analyses revealed six overarching themes: spiritual and religious beliefs, knowledge and beliefs about HIV, previous experience with childbearing attitudes of families and sex partners, personal health, and intrapersonal motivation to have a baby.

Self-care activities of women infected with human immunodeficiency virus

The article describes a qualitative focus group study exploring the self-care activities undertaken by women testing positive for human immunodeficiency virus (HIV) to promote and maintain their health. The sample included 27 women who participated in one of four focus group sessions. Participants represented women from both rural and urban settings in the South. Subjects talked about and described the ways in which they took care of themselves. Content analysis was used to code the data and to determine major categories of activities. Seven categories were identified: special dietary and nutrition practices, choosing not to use medically prescribed therapies, spiritual reliance and rituals, staying active, cognitive strategies, self-education, and adopting healthy life styles. These findings support the value of developing a holistic approach to health care of women infected with HIV.

Barriers to health-seeking behaviors for women infected with HIV

There is a growing need to develop services for women with human immunodeficiency virus (HIV) infection, despite the reluctance of many to seek help. Yet, there is limited knowledge of the forces that act as barriers to health-seeking behaviors among these women. In the analysis of this focus group study of 46 women with HIV, eight distinct categories of perceived barriers to care were identified. These were: Lack of knowledge on the part of health care providers, fear of negative treatment, insensitivity of health care providers, fear by providers, lack of patient education, lack of confidentiality, lack of honesty, and blaming the victim. The women's descriptions of their experiences with health care providers are presented and discussed in the context of the potential impact of such behaviors on women's willingness to accept or continue treatment for HIV infection.

Knowledge and risk behaviors of people seeking HIV antibody testing at a community site

People seeking HIV antibody testing at a community-based AIDS service organization (N = 342) were asked to complete a self-report questionnaire to determine knowledge of HIV transmission, source(s) of HIV-related knowledge, and recent risk behaviors. The overall knowledge level of risk for transmitting HIV associated with 16 related behaviors was relatively high. Yet, 69% of the participants reported engaging in unsafe sex during the previous six months. Poorly informed subjects tended to overestimate their level of knowledge. In a multiple regression analysis, knowledge, age, and gender were the only significantly predictors of engaging in unsafe sex in this cohort. Nurses must be on the forefront in developing (1) strategies to reach people at high risk for HIV infection and HIV transmission, (2) culturally relevant and sensitive education, and (3) interventions that will enable people to make appropriate choices concerning high-risk behaviors.

HIV infection in rural communities

HIV/AIDS is recognized as a growing problem in rural America. The community response model presented in this article provides a framework for developing a comprehensive approach to HIV/AIDS education and services. The model, while providing guidance in program development, allows for the adaptation of the model to address the unique needs associated with rural communities. Two programs that have been successful in responding to the need for HIV-related knowledge and services in rural areas are also presented.

The Georgia Rural-Based Nurse Model: primary care for persons with HIV/AIDS

The need for specialized HIV education for nurses working in rural areas will increase as the incidence of HIV infection increases in rural areas. Public health nurses provide a viable alternative to providers in acute care facilities and will continue to be the primary care providers for persons with HIV/AIDS in rural areas. While approaches to HIV/AIDS education should include clinical treatment as the core, clinical knowledge alone will not promote the development of caring communities. The Rural-Based Nurse Model provides a comprehensive curriculum that addresses the many complex issues associated with the care of persons with HIV/AIDS. Additionally, participants are linked with care providers who serve clients across the continuum of HIV disease. Through meaningful educational opportunities and provider networking, this program has the potential for improving the quality of care in rural areas for persons with HIV/AIDS. HIV/AIDS education programs will require individualized community strategies that consider existing resources and barriers. However, the Rural-Based Nurse Model provides a formula for HIV/AIDS education that can be easily adapted to other settings.

Community-based HIV case management: challenges and opportunities

Over the past decade, case management has become a popular strategy for the organization and delivery of health service. Yet, in many settings, a lack of clarity exists as to the exact function and process of case management. The author addresses key issues in the debate surrounding case management and provides insight into how these issues can be resolved. The potential of case management in future healthcare restructuring and HIV/AIDS prevention is explored.

Obtaining services for HIV-positive patients

Services needed for HIV-positive persons and the availability of these services were reported in the July/August 1990 issue of JONA. This article includes further information from the original study--an analysis of the factors in each reporting hospital and community that enabled or barred the development of services for HIV-positive persons. This information offers strategies to nurse executives for obtaining services in their own settings.

Nursing education and HIV disease: a call for action

The continued increase in reported cases of HIV disease has created a compelling need for nursing educators to provide students with comprehensive information on HIV-related issues. The authors discuss the need for students to care for HIV-positive individuals under faculty supervision to overcome fear and anxiety. Faculty education is proposed as a first step to develop a comprehensive approach to HIV education. A guide for integrating HIV content into the curriculum is provided.

Impact of case management on hospital charges of PWAs in Georgia

To determine the effects of case management in controlling hospital based costs for persons with AIDS (PWAs), a retrospective review of records of deceased PWAs was performed. The study compared diagnosis-to-death hospital charges for PWAs who received care under a care management model (n = 60) with PWAs receiving care within a non-case managed approach (n = 60). Hospital charges were adjusted for inflation. PWAs receiving care within the case managed model had significantly lower hospital-based changes than the non-case managed group. Additionally, PWAs in the case managed group lived significantly longer between HIV diagnosis and death, and lived longer between their first AIDS-related hospital admission and death.