Health-Harming Legal Needs Identified by People with HIV
Data from a Medical-Legal Partnership Study to Improve HIV Care Continuum Outcomes
DOI:
https://doi.org/10.52609/jmlph.v5i2.159Keywords:
Health Services Accessibility, Health Inequities, HIV, Implementation Science, Quality of CareAbstract
Introduction: People with HIV (PWH) often face health-harming legal needs that impede access to and retention in HIV care. The Organizational Partnerships for Healthy Living (OPAHL) intervention addresses these gaps by integrating legal services with health care.
Methods: This mixed-methods study was conducted at two health centers in Philadelphia, PA, from October 20, 2022 through 2024. The trial aims to: (1) refine the OPAHL intervention prototype for PWH with detectable viral loads; and (2) test the feasibility, acceptability, and preliminary effects of OPAHL, which includes (a) comprehensive partner training; (b) screening for legal concerns; and (c) access to legal services. Key legal concerns were identified from 111 participants through quantitative and qualitative analyses of patient-reported responses and attorney case summaries.
Results: Major findings from the preliminary dataset reflect distinct categories of legal concerns reported by participants, including Personal/Advanced Care Planning (n = 50), Other Legal Concerns (n = 26), Unsafe Housing/Repairs (n = 23), and Eviction or Threat of Losing Home (n = 15).
Conclusions: Findings highlight the diverse and complex legal concerns impacting PWH, particularly in relation to personal and housing-related planning. Understanding and addressing these challenges is crucial for developing targeted interventions to strengthen the HIV care continuum.
References
Centers for Disease Control [Internet]. What is Health Equity? [updated 2024 Jun 11; about 4 screens].
Tinetti, ME, deCardi Hlakek M, Ejem D. One size fits all—An underappreciated health inequity. JAMA Intern Med. 2024 Jan 1;184(1):7-8.
Stewart KE, Phillips MM, Walker JF, Harvey SA, Porter A. Social services utilization and need among a community sample of persons living with HIV in the rural south. AIDS Care. 2011 Mar;23(3):340-347.
Kennedy MC, Kerr T, McNeil R, Parashar S, Montaner J, Wood E, Milloy MJ. Residential eviction and risk of detectable plasma HIV-1 RNA viral load among HIV-positive people who use drugs. AIDS Beh. 2017 Mar;21(3):678–687.
Pulitzer Z, Box M, Hansen L, Tiruneh YM, Nijhawan AE. Patient, medical and legal perspectives on reentry: the need for a low-barrier, collaborative, patient-centered approach. Health Justice. 2021 Dec 2;9(1):1-12. Erratum in: Health Justice. 2022 Apr 30;10(1):16.
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 and Acute Care Surg. 2024 Feb 1;96(2):340–345.
Burris S, Cameron E. The case against criminalization of HIV transmission. JAMA. 2008 Aug 6;300(5):578–581.
Lehman JS, Carr MH, Nichol AJ, Ruisanchez A, Knight DW, Langford AE, Gray SC, Mermin JH. Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS Behav. 2014 Jun;18(6):997–1006.
Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Bozack AK, Caban M, Rourke SB. Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review. Am J Pub Health. 2016 Jan;106(1):e1–e23.
Johnson DY, Asay S, Keegan G, Wu L, Zietowski ML, Zakrison TL, Muntz N, Pillai R, Tung EL. US medical-legal partnerships to address health-harming legal needs: Closing the health injustice gap. J Gen Intern Med. 2024 May;39(7):1204-1213.
Office of Community Services, Administration for Children and Families, U.S. Department of Health and Human Services [Internet]. Medical-Legal Partnerships Plus. [accessed December 28, 2024; about 5 screens].
Centers for Medicare and Medicaid Services [Internet]. A Guide to Using the Accountable Health Communities Health-Related Social Needs Screening Tool: Promising Practices and Key Insights. [updated December 2023; accessed December 28, 2024].
Hamilton AB. (2013). Qualitative methods in rapid turn-around health services research. [PDF]. Retrieved from https://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/780-notes.pdf
Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015 Sep;42(5):533-544.
Izenberg JM, Mujahid MS, Yen IH. Health in changing neighborhoods: a study of the relationship between gentrification and self-rated health in the state of California. Health Place. 2018 Jul;52:188–95.
Lim S, Chan PY, Walters S, Culp G, Huynh M, Gould LH. Impact of residential displacement on healthcare access and mental health among original residents of gentrifying neighborhoods in New York City. PLoS ONE. 2017 Dec 22;12(12):e0190139.
Whittle HJ, Palar K, Hufstedler LL, Seligman HK, Frongillo EA, Weiser SD. Food insecurity, chronic illness, and gentrification in the San Francisco Bay Area: an example of structural violence in United States public policy. Soc Sci Med. 2015 Oct;143:154–61.
Cluesman SR, Gwadz M, Freeman R, Collins LM, Cleland CM, Wilton L, Hawkins RL, Leonard NR, Silverman E, Maslow CB, Israel K, Ritchie A, Ory S. Exploring behavioral intervention components for African American/Black and Latino persons living with HIV with non-suppressed HIV viral load in the United States: a qualitative study. Int J Equity Health. 2023 Jan 31;22(1):1–29.
Earl TR, Saha S, Lombe M, Korthuis PT, Sharp V, Cohn J, Moore R, Beach MC. Race, relationships, and trust in providers among Black patients with HIV/AIDS. Soc Work Res. 2013 Sep 1;37(3), 219–226.
Feyissa GT, Lockwood C, Woldie M, Munn Z. Reducing HIV-related stigma and discrimination in healthcare settings: A systematic review of quantitative evidence. PLoS ONE. 2019 Jan 25;14(1):1–23.
Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, Mitchell EMH, Nelson LRE, Sapag JC, Siraprapasiri T, Turan J, Wouters, E. Stigma in health facilities: why it matters and how we can change it. BMC Med. 2019 Feb 15;17(1):25.
Pachankis JE, Bränström R. Hidden from happiness: Structural stigma, sexual orientation concealment, and life satisfaction across 28 countries. J Consult Clin Psychol. 2018 May;86(5):403–415.
Turan B, Browning W, Budhwani H, Turan J, Fazeli P, Raper J, Mugavero, M. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav. 2017 Jan; 21(1):283–291.
Nouri S, Lyles CR, Rubinsky AD, Patel K, Desai R, Fields J, DeRouen MC, Volow A, Bibbins-Domingo K, Sudore RL. Evaluation of neighborhood socioeconomic characteristics and advance care planning among older adults. JAMA Netw Open. 2020 Dec 1;3(12):e2029063.
National Center for Access to Justice [Internet]. Attorney Access (Choose a State - Pennsylvania). [accessed December 28, 2024; about 5 screens].
Serchen J, Hilden DR, Beachy MW, et al. Health and Public Policy Committee of the American College of Physicians. Meeting the health and social needs of America’s unhoused and housing-unstable populations: A position paper from the American College of Physicians. Ann Intern Med. 2024;177:514-517. [Epub 27 February 2024].
Garcia C, Doran K, Kushel M. Homelessness and health: Factors, evidence, innovations that work, and policy recommendations. Health Aff. 2024 Feb;43(2):164-171.
Liboro RM, Bell S, Flatt J, Pharr J, Ranuschio B, Barnes L, Navarro A, Ribeiro A, Sheik-Yosef N, Waldron JM. Lifetime experiences of housing insecurity among gay men living with HIV at midlife: An exploratory study utilizing a social determinants of health perspective. Soc Sci. 2024; 13(8):420.
Vest JR, Hinrichs RJ, Hosler H. How legal problems are conceptualized and measured in healthcare settings: A systematic review. Health & Justice. 2023 Nov 18;11(1):1–9.
National Center for Medical-Legal Partnership [Internet]. Impact. [accessed December 28, 2024; about 4 screens].
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Samantha Morton, Andrew Maude, Theresa Brabson, Hervette Nkwihoreze, Robin Davison, Miguel Munoz-Laboy, Omar Martinez

This work is licensed under a Creative Commons Attribution 4.0 International License.