Justice as care: embedding legal services into HIV care to address health-harming legal needs

People with HIV face a constellation of social and structural barriers, including unstable housing, discrimination, lack of identification documents, immigration issues, and denial of public benefits, that impede access to and retention in care. These health-harming legal needs are rarely addressed systematically in HIV service settings, despite longstanding calls for structural interventions. This study examines the role and impact of a Medical-Legal Partnership (MLP) embedded within The Philadelphia AIDS Consortium, in collaboration with the Legal Clinic for the Disabled. As part of a larger feasibility and acceptability trial, we conducted follow-up interviews with 95 participants who engaged with the on-site attorney. Recruitment was conducted via venue-based outreach, online ads, and peer referral. Participants reported a substantial reduction in legal needs over time, with more than half reporting no health-harming legal needs (HHLNs) by the 3- and 6-month follow-ups. The most common concerns at baseline, transportation, care planning, and food access, declined significantly. Thematic analysis revealed six key domains of impact: (1) empowerment and knowledge-building; (2) trust, respect, and cultural competence; (3) accessibility and integration of legal services; (4) practical legal resolution; (5) emotional relief and therapeutic benefit; and (6) limitations in legal scope or access. Findings underscore the transformative potential of MLPs in HIV care. When embedded in trusted, culturally responsive settings, legal services can help dismantle structural barriers, foster trust, and support both practical legal resolution and improved mental health outcomes.