Health Services and Policy Issues in AIDS Psychiatry

Health services research is a practically focused discipline drawing on the social and behavioral sciences and concerned with the organization, financing, and delivery of services. Investigators studying HIV services examine how well healthcare and other systems meet needs, eliminate disparities, integrate services, eliminate barriers, and provide care to socially marginal and stigmatized individuals, such as injection drug users and people who are incarcerated. These issues have been important from the earliest days of the HIV epidemic and have taken on increased significance as efficacious treatments have been developed and, more recently, changes in the financing of care have reduced the number of uninsured. This chapter this focuses primarily on research in the United States with a review of recent work on financing, service fragmentation, and difficulties integrating different sectors of care, as well as problems related to the functioning of medicine in a complex, stratified society. Also addressed are certain general features of the Affordable Care Act that are relevant to HIV care and psychiatry.