Challenges for the urban home health care provider. The New York City experience

This article describes the development and implementation of the AIDS home care program at the Visiting Nurse Service of New York (VNSNY). The challenges to VNSNY staff are diverse and include (1) dealing with staff who are infected or affected by HIV in their own families; (2) working with other community-based case managers; (3) working in high crime areas and dealing with substance abuse; (4) managing families in crisis; (5) dealing with violence and abuse in the home, including staff abuse; (6) managing problems with informal caregivers; (7) managing clients who participate in unsafe sexual activities; and (8) dealing with issues of HIV confidentiality.