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Health Soc Work. 2017 Mar 14:1-9. doi: 10.1093/hsw/hlx013. [Epub ahead of print]

Addressing Structural Barriers to HIV Care among Triply Diagnosed Adults: Project Bridge Oakland.

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Christina Powers, LCSW, is a licensed clinical social worker, San Francisco Public Defender's Office. Megan Comfort, PhD, is a senior research sociologist, RTI International, San Francisco. Andrea M. Lopez, PhD, is assistant professor, Department of Anthropology, University of Maryland, College Park. Alex H. Kral, PhD, is senior research epidemiologist, RTI International, San Francisco. Owen Murdoch, MD, is a physician, HIV Services, Family Health Centers of San Diego. Jennifer Lorvick, DrPH, is a senior public health scientist, RTI International, San Francisco. Address correspondence to Megan Comfort, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104; e-mail: This research was supported by funding from the National Institutes of Health (R01MH094090, PI: Kral; R01DA033847, PI: Comfort; and R01MD007679, PI: Lorvick). The authors thank Caroline Ahlstrom, David Greenberg, Elizabeth Kita, and the Project Bridge Oakland clients for their insights and collaboration.


People who are "triply diagnosed" with HIV, mental health issues, and substance-related disorders face tremendous barriers connecting to and remaining in HIV care. Authors of this article implemented Project Bridge Oakland (PBO), an intervention based on harm reduction and trauma-informed care, to help maintain continuity of care for triply diagnosed adults through cycles of criminal justice involvement. From August 2011 to December 2014, a clinical social worker and an HIV physician provided intensive case management for 19 clients living in Oakland, California. By working with clients across a multitude of community, clinic, and correctional spaces while maintaining a low threshold for services, the social worker was able to engage a severely marginalized population in HIV care. This article details the PBO strategies for assisting with a wide range of services needed for community stabilization, navigating criminal justice involvement, and establishing a therapeutic relationship through mundane practices such as eating and waiting for appointments. This article illustrates how programs aimed at stabilizing triply diagnosed clients in the community and connecting them to HIV care require coordination among providers, outreach to engage clients, ample time to work with them, and flexibility to account for the complexities of their day-to-day lives and experiences.


HIV; case management; homelessness; incarceration; mental health

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