Introduction: Women living with HIV have a myriad of health and social service needs, which are often unmet in the traditional health and social service system. Frequently women's service concerns fall through the cracks, especially in a system that was not necessarily designed to match the women's needs. A settlement house program in Los Angeles was designed to meet the diverse needs of women living with HIV.

Project Description: The presentation examines service utilization by clients of the women's settlement house program. Utilization patterns are examined in terms of their correspondence to client characteristics and expressed needs.

Results: Between October 1994 and November 1996, a total of 302 women with HIV received services from the settlement house program. The typical client profile is a single, heterosexual, African-American woman in her thirties living in stable housing with family or friends. On average, clients had two children, one of whom lived with them. A significant proportion of women appear to engage in risk behaviors currently, including substance abuse and sexual behaviors. In terms of service utilization, clients used case management and counseling and therapy most often. The most time was spent in individual therapy and counseling, support groups, and recreation. During each visit, women discussed health status, housing and jobs, and domestic violence most often. Most of the services were provided by social workers and case managers. In terms of items provided to clients, household and hygiene items were provided most often. Clients were often referred to HOPWA for housing assistance. In general, the higher the client's overall level of need, the lower their ratings of mental health, ability to follow through with referrals unassisted, ability to obtain transportation, ability to deal with barriers to obtaining services, and ability to comply with medical advice.

Implications: Results are discussed in the context of providing services that are individualized to women's needs in an environment that is perceived as safe and supportive for women to discuss their concerns, learn about community resources, and support each others' efforts to protect their health.