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Street Medicine Programs are designed to address the unique needs of the unsheltered homeless by delivering health and social services to them in their own environment. These programs play a critical role in addressing the Ending the HIV Epidemic (EHE) initiative, as discussed in the “Ending the HIV Epidemic: Cutting-Edge Models of Care” session presented at the 2023 IDWeek conference.

The Role of Street Medicine Programs
Poverty is a significant factor that contributes to the prevalence of HIV by 20 times. This is especially true for persons who inject drugs (PWID), who account for 10 percent of adult and adolescent HIV cases. This population also has different demographics, with a higher proportion of White individuals and those between the ages of 13 and 34 compared to other high-prevalence populations. Moreover, sharing needles, syringes, or other drug injection equipment puts PWID at a significantly higher risk for HIV and other infections.

Street Medicine Programs also serve as an opportunity to reach sex workers, who make up a significant portion of the street medicine population.

For all of these reasons, Street Medicine Programs are needed to provide essential access to pre-exposure prophylaxis (PrEP), clean needles, and education on harm reduction practices.

But the need for Street Medicine Programs goes beyond HIV prevention. Opioid-related deaths in the U.S. have increased by 500 percent over a 20-year period (1999-2019). This is especially alarming in the Tampa Bay region, where opioid-related deaths are 50 percent higher than the rest of the country at 15.5 percent. In 2020, the Tampa Bay region recorded a staggering 1,200 overdose deaths. Additionally, synthetic opioid deaths across the U.S. have increased by 73 percent from 2014 to 2015, and 1.6 million people had an opioid use disorder in the past year.

How Street Medicine Programs Work
In light of these alarming numbers, Street Medicine Programs are essential for providing immediate and accessible care. A Street Medicine Team is typically comprised of medical professionals, case managers, and community health workers.

Take, for instance, the Tampa Bay Street Medicine (TBSM) team, which was founded in 2014 and is made up of three service divisions. The first is referred to as “Street Runs,” which provides over-the-counter medications, health education, wound care, and vitals checks while the second division called Continuity Clinic focuses on providing primary care, women’s health, and podiatry services.

The third division is called IDEA Exchange, which is a mobile unit that is available at three locations each week. It provides anonymous and confidential HIV and HCV testing, syringe exchange, access to sterile equipment, and linkage to care for those with HIV or HCV. For those struggling with substance use disorders, the team can also distribute Narcan and link them to substance use and mental heath care.

In addition to the IDEA Exchange division, below are some other innovative steps the TBSM team has taken to assist the EHE initiative:

• Conduct telehealth appointments to start patients with uncontrolled HIV on antiretroviral therapy
• Inject the co-packaged antiretroviral medication Cabenuva outside of the traditional clinic
• Use research and education to reduce community viral load
• Train multidisciplinary students in street medicine and HIV care

Through these and other initiatives, street medicine programs, like TBSM, can help address the ongoing HIV and opioid epidemics and promote better health outcomes for those in this at-risk and vulnerable population.

Reference
Oxner, Asa. Street Medicine’s Role in EHE. IDWeek;October 11-15, 2023; Boston, MA. Introduction to Social Emergency Medicine (rackcdn.com). Accessed October 19, 2023.