Maxine Davis, Director of the Dr. Peter Foundation in Vancouver, BC describes the care of people with HIV/AIDS as “complex care,” because the often unstable lives of HIV positive individuals makes it very difficult for them to access or sustain treatment.

“As a health care system we haven’t figured out how to effectively connect and engage people in a sustained way with the treatment…It is because the profile of individuals who have yet to benefit from HIV treatment are individual’s whose lives are made very chaotic by mental illness and addiction,” she said.

She added that there are currently approximately 2000 people living with HIV/AIDS in British Columbia who need to be on HAART but aren’t.

The Dr. Peter Model

This is where the Dr. Peter Centre finds its niche.  The Centre, located in downtown Vancouver, provides 24-hour nursing care to 24 HIV-positive residents, and runs a Day Health program that offers meals, nursing care and other activities to 90 to 120 PHAs per day.  The organization specializes in bringing stability to chaotic lives.  One resident has been living at the Centre for more than one and a half years, the longest time he has lived anywhere.

“The physical illness part is one piece, but it is really finessing coping with the serious mental illness and the active drug addiction where we do a tremendous job, certainly what we can share with others”

Part of this is including supervised drug injection in their program for both residents and members of the Day Health program, an action supported by data and the endorsement of the British Columbia Medical Officers of Health.

Advice for Other Service Providers

Given the success of the Dr. Peter model, I asked Maxine what advice she would give to others working in the field of HIV/AIDS and Housing.  She looks at housing for people living with HIV/AIDS as a pyramid.  At the base of the pyramid are those who are very good at self-care, which is the majority of PHAs.  They need access to “affordable housing,” ensuring that their monthly rent doesn’t put them into poverty.  At the middle level of the pyramid are PHAs who need “supportive housing.”  This group is relatively healthy, but may face housing insecurity because of behaviours related to mental health and active drug addiction.

“Once you reach out to HIV-positive people who also have mental health and addiction issues, it brings you into a situation where there’s going to need to be more staff support built in so that they can be supported through the behaviours that come with the issues in their lives rather than ending up losing their housing”

The group at the top of the pyramid requires both supportive housing and also 24-hour nursing care to manage symptoms and treatment.  Service providers must be able to correctly identify which group their clients fall into, and know where to find the necessary care for each group.

For organizations that want to adopt the Dr. Peter model and are wondering how to get government support, Maxine recommends highlighting the role this kind of program has in reducing expensive hospital visits and stays.   “We’ve shown in our residence that within one year of admission to the residence, clients had 36 percent fewer emergency visits, and 72 percent fewer inpatient hospital days.”  A hospital bed in Vancouver costs approximately $1500 to $2000 per day, whereas the Dr. Peter residence and Day Health program cost approximately $212 and $50 per day, respectively.

The nexus of housing insecurity, mental illness, addiction and HIV/AIDS in Vancouver and elsewhere complicates treatment.  The Dr. Peter Centre has found effective ways to manage the chaos in its clients’ lives and help them to gain stability, as well as access to treatment and care.