U.S. Mayor Article

Investments, Comprehensive Prevention, Care Are Key to Services, Quality of Life for San Juan Residents with HIV/AIDS

April 1, 2002

The HIV/AIDS epidemic has had a critical impact on the families, communities and health care system in the City of San Juan. As of January 31, 2002 a total of 26,833 cumulative AIDS cases have been reported in Puerto Rico, 24.4% of them, or 6,561 in the City of San Juan. A total of 564 of reported cases island'wide were children and adolescents, 25.8% or 146 of these were in the City of San Juan.

San Juan's AIDS Program (SJAP) is an integral part of the City's Health Department programming. Known locally as 'Golden Relief' it emphasizes resident service by providing Environmental Security, Continuous Quality Improvement, Infection Control and Education. More importantly, SJAP provides comprehensive clinical services for HIV/AIDS'infected clients, preventive services for those at risk of infection and educational programs for the population at large. SJAP's mission is to provide high quality comprehensive services to the HIV/AIDS patients and families resident in San Juan and clients receive physical, mental, social and spiritual treatment. Education and preventive services equip patients and families to live with their condition and improve their quality of life. To provide high quality health care, the City has led the effort to improve services in an environment of dedication and human respect while ensuring access to services.


Clinical services for HIV'infected patients are provided through a comprehensive system of primary and secondary care, with tertiary care provided at San Juan's Municipal Hospital. An integrated referral and case management system links the three levels of care and the various services provided at each level. The program's centerpiece is a case management system designed to meet diverse needs and facilitate access to appropriate services. The development and organization of these HIV/AIDS client services has been guided by the concept of One'Stop Shopping ' that is, a spectrum of services housed in one facility to help meet the needs of patients and their families.

Integrated community-based Organizations (CBO's)

In addition to walk'ins, patients/clients are also channeled to SJAP through an established referral system with Community Based Organizations (CBO's) from the San Juan Metropolitan Region Ryan White Title I consortium. SJAP provides a full range of services that include: primary physician care, mental health, case management, oral health, nutrition, ambulatory treatment, skilled nursing, medication, home care, laboratory services, extended care, diagnostic studies, outreach education and prevention and comprehensive specialized pediatric services. A referral system for contracted specialized services is also in place.

Rehabilitation Day Care Center

SJAP offers extended daily hours for its Rehabilitation Day Care Center and care clinic known locally as ACCES until 10:00 pm Monday thru Thursday and from 8:00 AM to 12:00 PM Saturdays. The outpatient unit opens 365 days a year, and until 10:00 PM Monday thru Thursday to provide support to the ACCES clinic. The Day Care Unit assists patients to reintegrate socially to their families and communities, improve their quality of life, develop skills and strengthen their self'esteem. The unit is equipped with individual treatment areas, a full'time physician and registered and practical nursing staff. Home Health Care services are provided to patients who are unable to travel to the clinic. Data shows significant decreases in hospitalizations in recent Pediatric HIV/AIDS

Pediatric HIV/AIDS

San Juan's Pediatric AIDS Clinic (SJPAC) provides services to infected and exposed infants and children. Clinic facilities are situated at a nearby San Juan Health Department Diagnostic and Treatment Center (DTC) and SJAP is making arrangements to co'locate the clinic facilities. Eight DTC's are located in different parts of the city. All SJPAC services provided have been integrated with other services offered by different city and state agencies according to the circumstances and identified patient/family needs.

In addition to medical and nursing staff SJPAC has two additional health educators and a part-time counselor assigned to community outreach and prevention. Each are integrated to the SJAP Educational Department outreach staff.

Case management services are provided to evaluate the psychosocial and economic needs of patients, including home visits and via community agency. Where appropriate patients and families are referred to government agencies for other services. Home care/visiting nursing services are coordinated for patients/families in need. Childcare services are coordinated for affected families in order to reduce absenteeism. Nutritional evaluation is conducted and recommendations made according to identified needs. Mental health services are provided to infected patients and affected families through clinic psychologists and SJAP psychiatric services.

Prevention & Education

Clinic health educators focus on individual patient and family health education but also perform group educational activities. Two health educators assigned to outreach and prevention are integrated to SJAP outreach staff who are responsible for the coordination and development of all educational activities to be conducted in different communities in the city. Health Educator services focus on the mode of transmission of infection and are perhaps one of the most important elements in controlling the spread of HIV. Laboratory testing and counseling services are provided at the eight DTC's through on'site HIV Prevention and Detection clinics. Each has the services of a registered nurse and a prevention counselor.

Women and Mothers

Hospitalization services are provided at the San Juan Municipal Hospital and SJPAC care and counseling are provided at SJAP ambulatory clinics. Women with HIV/AIDS are referred for Obstetrics and Gynecology services to the most accessible DTC, the closest to their residence or the provider of their choice. Prenatal care is provided by the DTC or at Obstetrics and Gynecology at the hospital where they are referred for clinical trials. Case managers are assigned in order to stay informed of family health status and to coordinate services. In cases where more than one family member is served, different case managers collaborate to ensure family'centered care. DTC's also offer evening hours every Thursday, a strategy again employed to reduce clinic or For more information on the City of San Juan's HIV/AIDS Program "Golden Relief" please contact Dr. Alfredo Escalera, Executive Director, San Juan Health Department, Salud de la Capital, P.O. Box 21405, City of San Juan, Puerto Rico 00928. (787) 977-0520.

For more information on the City of San Juan's HIV/AIDS Program "Golden Relief" please contact Dr. Alfredo Escalera, Executive Director, San Juan Health Department, Salud de la Capital, P.O. Box 21405, City of San Juan, Puerto Rico 00928. (787) 977-0520.

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