COMMUNITY-SERVICE NEEDS OF PEOPLE WITH HIV-INFECTION IN LONDON

The objectives of this study were to describe the expressed needs for community services of HN-infected individuals by disease stage, gender and transmission category and the barriers which prevent the receipt of such services. Structured interviewer-administered questionnaires c oncerning a 6-month retrospective period were used to obtain informati on on need for community services and problems which prevented the rec eipt of services. The study sample included 70 homosexual men with asy mptomatic HN disease, 42 homosexual men with symptomatic non-AIDS, 53 homosexual men with AIDS, 23 heterosexual men, 29 heterosexual women, 9 male and 9 female injecting drug users. The main outcome measures we re the extent to which needs for community services were met and perso n/service combinations for which problems or barriers prevented the re ceipt of community services. On average, subjects expressed a need for to categories of community services over the 6-month period: homosexu als expressed a mean of 10, heterosexuals 10, injecting drug users II, subjects with asymptomatic HIV infection 9, subjects with symptomatic non-AIDS 11, subjects with AIDS 13, men 9 and women 14. A total of 58 % of community service needs were always met, 6% were rarely not met, 16% were sometimes not met, 6% were often not met and 14% were not met at all. The extent to which subjects felt that their needs were met w as similar for the different study groups, but the needs of women were met somewhat less frequently than those of men. Similarly, people wit h AIDS felt that their needs were met slightly less often. Reported le vels of unmet need were high for a wide range of services. The most co mmon reason subjects gave for not having received a community service for which they expressed a need was ignorance of where or how to obtai n the service. This was mentioned in one-third of aa such cases. Anxie ties over the competence with which a service would be rendered was me ntioned in 13% of cases and long waiting times in 11%. The frequencies of unmet need for many community services were high and often seemed to arise either fi om a lack of awareness on the part of subjects on h ow and where services could be obtained or from doubts about the relev ance of services offered Both of these barriers should be surmountable through the provision of better information to patients, extending us er involvement in service development and the better co-ordination of service delivery through care management approaches.