An Invisible Barrier to Integrating HIV Primary Care with Harm Reduction Services: Philosophical Clashes between the Harm Reduction and Medical Models

• Published in: Public health reports (1974) 2004-01, Vol.119 (1), p.32-39
• Main Authors: Heller, Daliah, McCoy, Kate, Cunningham, Chinazo
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Biological and medical sciences; Collaboration; Community-Institutional Relations; Cooperative Behavior; Decision Making, Organizational; Delivery of Health Care, Integrated - organization & administration; Drug design; General aspects; Harm reduction; Health care delivery; Health care policy; Health Promotion - organization & administration; Health Services Accessibility; HIV; HIV Infections - complications; HIV Infections - prevention & control; Hospitals, Urban - organization & administration; Human immunodeficiency virus; Human viral diseases; Humans; Ideology; Infectious diseases; Interinstitutional Relations; Medical sciences; Miscellaneous; Models, Organizational; New York City; Organizational Case Studies; Partnerships; Patient-Centered Care; Philosophy, Medical; Physicians; Practice Articles; Primary care; Primary health care; Primary Health Care - organization & administration; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Social Medicine - education; Social Medicine - organization & administration; Social services; Substance abuse; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - prevention & control; Urban Health Services - organization & administration; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1177/003335490411900109

Overall AIDS mortality in the United States has declined in recent years, but declines have not been consistent across all populations. Due to an array of barriers to care, minorities and poor people who are active substance users have not benefited as others have from advances in the treatment of HIV disease. One way to address this problem is to integrate HIV primary care into harm reduction programs that already effectively serve this population. Such collaborations, however, are difficult to initiate and sustain. Philosophical differences between the medical model and the harm reduction model, which often remain invisible to the parties involved, underlie these difficulties. This article addresses the issue by describing a partnership in the Bronx, NY, between CitiWide Harm Reduction Inc. (CitiWideHR) and the Montefiore Medical Center. It focuses specifically on the sources of philosophical differences between models, and briefly assesses the potential for successful collaborations of this sort.