I agree, integrated health and social service needs should be a priority for people diagnosed with HIV. Unfortunately, many communities simple do not have the funds to support housing needs for everyone who needs them. The majority of people who are homeless are in great need of behavioral health (mental health and substance abuse) treatment, or treatment for a physical condition, such as diabetes, or HIV.

Chronic illness impacts a persons ability to work, this leaves millions of people without a safe place to live and the number is growing. People who are homeless are often unable to access health care and treatment, unable to adhere to medication if they did have access, and unable to eat nutrition meals.

Our health care system is broken for the most vulnerable in our society. The health system functions well for some, but the cracks in the system for others are wide and getting deeper by the day.

System level changes are needed to impact the health and wellness of those in our society who need it most.

#Systemthinking

Vickie Lynn, your point was my first thought: where does the money come from to pay for all of this? It's not that PLWH are unworthy in my opinion; however, there is an infinite list of "persons" who "need" all sorts of things, but there are not infinite funds. I have lived with disability, and struggled to stay employed (fortunately, I can be self-employed as a psychotherapist and have some flexibility that allows me to do this; I don't know that I would be able to deliver to an employer what an employer would need in terms of stamina, reliability, etc.). Partial disability would have helped me a lot at various times in my life. So, I can only imagine how scary it must be to be even sicker, and on the streets. That was my worst fear.

At the same time, how do we provide for all who need without bankrupting the system? Since it is so expensive to do so, it does matter that there are those who "game" the system as they take needed funds from those who are worse off. How do we avoid this?

It's a terrifying thought to accept a Dickensian view of life (or shall I say Hugoesque?), but I wonder will we ever be able to provide for all who need? Even in social systems set up to provide for such individuals, people still fall through the cracks, and their governments are going bankrupt as these things cost significantly.

Americans want to see socialized medicine; they don't understand the limitations imposed. I am from Canada, and while I'm not entirely against the idea, what I do see is that it doesn't necessarily solve the problems folks think it does. There is much comparison between the Canadian and American systems, and yet, few know the various things that the Canadian system doesn't cover (which shows to me that it isn't actually cheaper in any meaningful sense of the word). It covers only the basics, and in the U.S., healthcare covers more. Mortality rates don't give the whole picture.

As only one example, outpatient psychotherapy is NOT covered in most countries that have socialized medicine. That means it has to be paid for out of pocket. By itself, that shows that persons would still have to put out approximately $400 a month in most urban areas simply to have something that Americans pay much less for. And that's only one example.

I know this doesn't explain a lot, but my point is simply that human needs are infinite, resources are not. How are these needy people provided for in such a way that doesn't bankrupt the system? The idea that there is somehow enough money out there if we just tax the rich enough seems to me to be pie-in-the-sky thinking (as they can simply leave the country and take their money elsewhere, and they already pay a large portion of the tax bill).

I don't know the answers. Just throwing out, in a rather unsystematic manner, my thoughts. I hate seeing the homeless on the streets in New York City. But, to some extent, I understand why some want to stay homeless -- because the solutions offered by the system are disempowering and insufficient (I mean let's just look at the deplorable state of public housing in New York City, the infrastructure, the high cost of living despite all kinds of funds being thrown at those in need, the poor standard of living -- and this is in a place that purports to "help" people). I'm not sure it does. I used to think so, but after living there for 20 years, I began to have doubts. I saw that much of the money utilized to pay for programs for the needy were eaten up by graft not only on the part of individuals, but even more importantly, on the part of nonprofit institutions and policiticans. How many politicians have wound up in jail for diverting public funds? How often do public funds disappear (i.e., the Port Authority of New York)? How do we prevent less than benevolent nonprofits from gaming the system?

Would cracking down on graft at all levels solve the problem of insufficient funds? Or is there more to it than this? Honestly, I don't know the answer to this question, but I do know that there is always talk about how to provide for people but it's without regard for cost and where the funds will come from (and politicians will start gunning for everyone's money, not just the rich, at some point). The middle class cannot take up this burden. They deserve the fruits of their hard labor. It's not like it's that much, and if they don't, where's the incentive to work? I don't know about you folks, but if 70% of my paycheck were eaten up by taxes, I probably wouldn't work as much.

It’s a legislation thing. These important groups need an entitlement to ring-fenced state care funded by the tax payer. So many priority groups are shut out when services are resource-dependent. Also it can turn into a post code lottery.