San Francisco has the highest cumulative rate for AIDS of any metropolitan area in the nation. Young people in this city are continuing to contract HIV at very high rates. Currently, there is a scarcity of both effective treatment services and a comprehensive referral network to successfully engage multi-diagnosed young adults needing HIV/AIDS services and behavioral health care. Walden House Young Adult HIV component (YAH) addresses these issues, offering options to young people living with HIV/AIDS, as well as providing professionals working with young clients needed information on practical treatment methods.

YAH provides comprehensive treatment services for HIV-positive young adults within the context of a therapeutic community-based substance abuse rehabilitation setting. The target population is multi-diagnosed adolescents and young adults — addicts living with or at high-risk for acquiring HIV/AIDS and suffering from co-occurring psychiatric disorders. The project’s services help clients gain access to substance abuse treatment, mental health services, and HIV care. In addition, the project aims to increase treatment retention and decrease high-risk behaviors through peer-based case management and a coordinated continuum of services. This support system includes: medical and psychological assessment; referral and coordination; therapy and counseling services; alternative healing strategies (e.g., acupuncture and herbal medicine); transportation; peer education and counseling; legal information and referral; and long-term case management. Furthermore, YAH provides HIV testing access, pre- and post-test counseling, HIV and STD education, HIV-positive speakers as role models and street outreach workers, and training for community professionals.

Walden House operates a social model detoxification and safe housing unit as a gateway for HIV-positive young adults to enter treatment. YAH has increased client access and placement by intensifying outreach, improving interorganizational linkages, working with runaways and street youth, and extending the eligible age range to 25. In addition, after encountering certain barriers, staff developed solutions to foster close working relationships with traditional placement agencies, such as the juvenile justice and human services departments, while cultivating referrals from other community-based organizations serving similar populations. These relationships have become increasingly important as the project continues to develop a model of care with diverse and youth-friendly features, including treatment virtually on-demand. With the refinement of these features, the recruitment and retention of young people with HIV/AIDS into residential treatment has increased over time.

One study was conducted to examine the issues concerning specialized care and treatment for young people living with HIV in substance abuse treatment. As the chart below indicates, those clients living with HIV/AIDS required far more intensive services than their seronegative counterparts, and departed prematurely at twice the rate of their peers. In particular, it was found that study participants exhibited a wide range of specialized needs, including services for stress, fatigue and depression, which interfere with full program participation. Despite these obstacles, YAH clients receive four hours of mental health and HIV care interventions per day, in addition to recreational outings and other services. Another study done by the project revealed that youth appreciated the safety and support of the program, and felt good about taking care of themselves. Young people remaining in the program reported improvement on more than 60 percent of the well being measures. As well, YAH training for Walden House staff resulted in significant improvement in self-reported preparedness in dealing with youth-related HIV issues.

For further information contact Brian Greenberg, Ph.D., Walden House, Inc., 520 Townsend Street, San Francisco, CA 94103, 415.554.1100, ext. 103, bgreenb488@aol.com (e-mail).

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