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1.
MMWR Morb Mortal Wkly Rep ; 69(2): 35-39, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945033

RESUMO

Transgender women* in the United States are disproportionately affected by human immunodeficiency virus (HIV) infection because of multiple factors, including stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors, such as sex work, unprotected receptive anal intercourse, and injection drug use, that tend to increase their vulnerability to becoming infected with HIV (1,2). In a recent meta-analysis of 88 U.S. studies conducted during 2006-2017, the mean estimated laboratory-confirmed prevalence of HIV infection among transgender women was 14.2%, and the mean self-reported prevalence estimate was 21.0% (3). The Ending the HIV Epidemic initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States (4). HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services. CDC analyzed HIV partner services data submitted by 61 health departments† during 2013-2017. Among 208,304 index persons, 1,727 (0.8%) were transgender women. Overall, 71.5% of index transgender women were interviewed for partner services, which was lower than that for all index persons combined (81.1%). Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). Fewer than half (46.5%) of notified transgender women partners were tested for HIV, and approximately one in five (18.6%) of those who were tested received a new diagnosis of HIV infection, slightly higher than for all partners combined (17.6%). Additional efforts are needed to effectively implement partner services among transgender women and identify those whose infection with HIV is undiagnosed, provide timely prevention and care services, reduce HIV transmission, and contribute to ending the HIV epidemic.


Assuntos
Assistência à Saúde , Infecções por HIV/terapia , Parceiros Sexuais , Pessoas Transgênero , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados Unidos/epidemiologia , Adulto Jovem
2.
MMWR Morb Mortal Wkly Rep ; 68(4): 81-86, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30703079

RESUMO

Identifying persons with human immunodeficiency virus (HIV) infection who are unaware of their infection status, linking them to HIV care, and reducing racial/ethnic disparities are important national HIV prevention goals (1). Blacks/African Americans (blacks)* are disproportionately affected by HIV infection in the United States. Although blacks represent 13% of the U.S. population (2), in 2017, 44% of diagnoses of HIV infection were in blacks, and the rate of new diagnoses in blacks (41.1 per 100,000 persons) was approximately eight times that of non-Hispanic whites (5.1) (3). HIV partner services are offered by health officials to persons with diagnosed HIV infection (index patients) and their sex- or needle-sharing partners, who are notified of their potential HIV exposure and offered HIV testing and related services (4). CDC analyzed 2016 data from the National HIV Prevention Program Monitoring and Evaluation system submitted by 59 health departments.† Among 49,266 index patients identified as potential candidates for partner services, 21,191 (43%) were black. The percentage of black index patients interviewed for partner services (76%) was higher than that for all index patients combined (73%). Among the 11,088 black partners named by index patients, 78% were notified of their potential HIV exposure. Fewer than half (47%) of those notified were tested for HIV infection. Among those tested, one in six (17%) received a new HIV diagnosis. The prevalence of newly diagnosed HIV infection was particularly high among black partners who were gay, bisexual, and other men who have sex with men (MSM) (37%) and transgender persons (38%). Effective implementation of partner services is important to identify HIV infection, link patients to care or reengage them in care, and provide prevention services to reduce HIV transmission.


Assuntos
Afro-Americanos/estatística & dados numéricos , Assistência à Saúde/etnologia , Infecções por HIV/etnologia , Parceiros Sexuais , Adolescente , Adulto , Feminino , Infecções por HIV/terapia , Pesquisas sobre Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
5.
Public Health Rep ; 133(2_suppl): 87S-100S, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30457956

RESUMO

OBJECTIVE: The Care and Prevention in the United States (CAPUS) Demonstration Project was a 4-year (2012-2016) cross-agency demonstration project that aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states (Georgia, Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, and Virginia). Its goals were to increase the identification of undiagnosed HIV infections and optimize the linkage to, reengagement with, and retention in care and prevention services for people with HIV (PWH). We present descriptive findings to answer selected cross-site process and short-term outcome monitoring and evaluation questions. METHODS: We answered a set of monitoring and evaluation questions by using data submitted by grantees. We used a descriptive qualitative method to identify key themes of activities implemented and summarized quantitative data to describe program outputs and outcomes. RESULTS: Of 155 343 total HIV tests conducted by all grantees, 558 (0.36%) tests identified people with newly diagnosed HIV infection. Of 4952 PWH who were presumptively not in care, 1811 (36.6%) were confirmed as not in care through Data to Care programs. Navigation and other linkage, retention, and reengagement programs reached 10 382 people and linked to or reengaged with care 5425 of 7017 (77.3%) PWH who were never in care or who had dropped out of care. Programs offered capacity-building trainings to providers to improve cultural competency, developed social marketing and social media campaigns to destigmatize HIV testing and care, and expanded access to support services, such as transitional housing and vocational training. CONCLUSIONS: CAPUS grantees substantially expanded their capacity to deliver HIV-related services and reach racial/ethnic minority groups at risk for or living with HIV infection. Our findings demonstrate the feasibility of implementing novel and integrated programs that address social and structural barriers to HIV care and prevention.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/terapia , Grupos Minoritários , Aceitação pelo Paciente de Cuidados de Saúde , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Síndrome de Imunodeficiência Adquirida/terapia , Grupos de Populações Continentais , Competência Cultural , Grupos Étnicos , Infecções por HIV/etnologia , Humanos , Marketing Social , Estados Unidos
6.
Public Health Rep ; 133(2_suppl): 60S-74S, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30457958

RESUMO

OBJECTIVES: The Care and Prevention in the United States Demonstration Project included implementation of a Data to Care strategy using surveillance and other data to (1) identify people with HIV infection in need of HIV medical care or other services and (2) facilitate linkages to those services to improve health outcomes. We present the experiences of 4 state health departments: Illinois, Louisiana, Tennessee, and Virginia. METHODS: The 4 state health departments used multiple databases to generate listings of people with diagnosed HIV infection (PWH) who were presumed not to be in HIV medical care or who had difficulty maintaining viral suppression from October 1, 2013, through September 29, 2016. Each health department prioritized the listings (eg, by length of time not in care, by viral load), reviewed them for accuracy, and then disseminated the listings to staff members to link PWH to HIV care and services. RESULTS: Of 16 391 PWH presumed not to be in HIV medical care, 9852 (60.1%) were selected for follow-up; of those, 4164 (42.3%) were contacted, and of those, 1479 (35.5%) were confirmed to be not in care. Of 794 (53.7%) PWH who accepted services, 694 (87.4%) were linked to HIV medical care. The Louisiana Department of Health also identified 1559 PWH as not virally suppressed, 764 (49.0%) of whom were eligible for follow-up. Of the 764 PWH who were eligible for follow-up, 434 (56.8%) were contacted, of whom 269 (62.0%) had treatment adherence issues. Of 153 PWH who received treatment adherence services, 104 (68.0%) showed substantial improvement in viral suppression. CONCLUSIONS: The 4 health departments established procedures for using surveillance and other data to improve linkage to HIV medical care and health outcomes for PWH. To be effective, health departments had to enhance coordination among surveillance, care programs, and providers; develop mechanisms to share data; and address limitations in data systems and data quality.


Assuntos
Infecções por HIV/terapia , Acesso aos Serviços de Saúde/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde , Administração em Saúde Pública , Vigilância em Saúde Pública/métodos , Humanos , Estados Unidos
7.
Public Health Rep ; 132(4): 455-462, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28614670

RESUMO

OBJECTIVE: Human immunodeficiency virus (HIV) partner services are an integral part of comprehensive HIV prevention programs. We examined the patterns of HIV testing and positivity among partners of HIV-diagnosed people who participated in partner services programs in CDC-funded state and local health departments. METHODS: We analyzed data on 21 484 partners submitted in 2013-2014 by 55 health departments. We conducted descriptive and multivariate analyses to examine patterns of HIV testing and positivity by demographic characteristics and geographic region. RESULTS: Of 21 484 partners, 16 275 (75.8%) were tested for HIV; 4503 of 12 886 (34.9%) partners with test results were identified as newly HIV-positive. Compared with partners aged 13-24, partners aged 35-44 were less likely to be tested for HIV (adjusted odds ratio [aOR] = 0.86; 95% confidence interval [CI], 0.78-0.95) and more likely to be HIV-positive (aOR = 1.35; 95% CI, 1.20-1.52). Partners who were male (aOR = 0.89; 95% CI, 0.81-0.97) and non-Hispanic black (aOR = 0.68; 95% CI, 0.63-0.74) were less likely to be tested but more likely to be HIV-positive (male aOR = 1.81; 95% CI, 1.64-2.01; non-Hispanic black aOR = 1.52; 95% CI, 1.38-1.66) than partners who were female and non-Hispanic white, respectively. Partners in the South were more likely than partners in the Midwest to be tested for HIV (aOR = 1.56; 95% CI, 1.35-1.80) and to be HIV-positive (aOR = 2.18; 95% CI, 1.81-2.65). CONCLUSIONS: Partner services programs implemented by CDC-funded health departments are successful in providing HIV testing services and identifying previously undiagnosed HIV infections among partners of HIV-diagnosed people. Demographic and regional differences suggest the need to tailor these programs to address unique needs of the target populations.


Assuntos
Infecções por HIV/diagnóstico , Soropositividade para HIV/diagnóstico , Programas de Rastreamento/métodos , Parceiros Sexuais/psicologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Soropositividade para HIV/virologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual
8.
MMWR Morb Mortal Wkly Rep ; 65(40): 1099-1103, 2016 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-27736833

RESUMO

The 2015 National HIV/AIDS Strategy provides an updated plan to address health disparities in communities at high risk for human immunodeficiency virus (HIV) infection (1,2). Hispanics/Latinos* are disproportionately affected by HIV in the United States. In 2014, 23% of HIV diagnoses were among Hispanics/Latinos, who represented 16% of the U.S. population (3). To examine HIV testing services, CDC analyzed 2014 data from the National HIV Prevention Program Monitoring and Evaluation (NHM&E) system submitted by 60 CDC-funded health departments† and 151 community-based organizations. Among Hispanics/Latinos tested, gay, bisexual, and other men who have sex with men (MSM) had the highest percentage of HIV diagnoses (2%). MSM accounted for 19.8% of HIV test events conducted among Hispanics/Latinos and 63.8% of Hispanics/Latinos who received an HIV diagnosis in non-health care settings.§ Approximately 60% of Hispanics/Latinos who received an HIV diagnosis were linked to HIV medical care within 90 days; this percentage was lower in the South than in other U.S. Census regions. HIV prevention programs that are focused on expanding routine HIV screening and targeting and improving linkage to medical care and other services (e.g., partner services) for Hispanics/Latinos can help identify undiagnosed HIV cases and reduce HIV transmission.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Feminino , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Porto Rico/epidemiologia , Pessoas Transgênero/estatística & dados numéricos , Estados Unidos/epidemiologia , Ilhas Virgens Americanas/epidemiologia , Adulto Jovem
9.
AIDS Care ; 28(5): 554-60, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27045327

RESUMO

The Centers for Disease Control and Prevention's (CDC) expanded testing initiative (ETI) aims to bolster HIV testing among populations disproportionately affected by the HIV epidemic by providing additional funding to health departments serving these communities. ETI prioritizes testing in clinical settings; therefore, we examined the relationship between state-level ETI participation and past-year HIV testing among a racially/ethnically diverse sample of adult respondents to the 2012 Behavioral Risk Factor Surveillance System who accessed health services within the 12 months prior to being interviewed. Controlling for individual- and state-level characteristics in a multilevel logistic regression model, ETI participation was independently and positively associated with past-year testing, but this association varied by race/ethnicity. Hispanics had higher odds (adjusted odds ratio [AOR]: 1.49; 95% CI: 1.11-2.02) and American Indian/Alaska Natives had lower odds (AOR: 0.66; 95% CI: 0.43-0.99) of testing if they resided in states with (vs. without) ETI participation. State-level ETI participation did not significantly alter past-year testing among other racial/ethnic groups. Prioritizing public health resources in states most affected by HIV can improve testing patterns, but other mechanisms likely influence which racial/ethnic groups undergo testing.


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Grupos Étnicos/estatística & dados numéricos , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Programas de Rastreamento/métodos , Adolescente , Adulto , Afro-Americanos , Idoso , Estudos Transversais , Grupo com Ancestrais do Continente Europeu , Feminino , Infecções por HIV/psicologia , Hispano-Americanos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multinível , Vigilância da População , Avaliação de Programas e Projetos de Saúde , Estados Unidos/epidemiologia
10.
Public Health Rep ; 130(5): 514-25, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26327729

RESUMO

OBJECTIVE: This study examined temporal trends in HIV testing among U.S. older adults (50-64 years of age) before and after the release of CDC's routine HIV testing recommendations in 2006. METHODS: The sample (n=872,797; 51.4% female) comprised 2003-2010 Behavioral Risk Factor Surveillance System respondents in the oldest categories to which the recommendations apply: 50-54 years (34.5%, n=301,519), 55-59 years (34.1%, n=297,865), and 60-64 years (31.3%, n=273,413). We calculated (1) four-year pooled prevalences of past-year HIV testing before and after 2006, when the recommendations were released; and (2) annual prevalences of HIV testing overall and by age category from 2003-2010. Using weighted, multivariable logistic regression analyses, we examined binary (pre- vs. post-recommendations) and annual changes in testing, controlling for covariates. We stratified the data by recent doctor visits, examined racial/ethnic differences, and tested for linear and quadratic temporal trends. RESULTS: Overall and within age categories, the pooled prevalence of past-year HIV testing decreased following release of the recommendations (p<0.001). The annual prevalence decreased monotonically from 2003 (5.5%) to 2006 (3.6%) (b=-0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (b=0.01, p<0.001). By race/ethnicity, testing increased over time among non-Hispanic black people only. Annual prevalence also increased among respondents with recent doctor visits. CONCLUSION: CDC's HIV testing recommendations were associated with a reversal in the downward trend in past-year HIV testing among older adults; however, the gains were neither universal nor sustained over time.


Assuntos
Sorodiagnóstico da AIDS/normas , Infecções por HIV/diagnóstico , Comportamentos Relacionados com a Saúde , Programas de Rastreamento/normas , Sorodiagnóstico da AIDS/tendências , Distribuição por Idade , Sistema de Vigilância de Fator de Risco Comportamental , Escolaridade , Feminino , Fidelidade a Diretrizes/tendências , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Estado Civil , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Saúde das Minorias/estatística & dados numéricos , Análise Multivariada , Prevalência , Assunção de Riscos , Estados Unidos/epidemiologia
11.
Am J Public Health ; 105(9): 1917-25, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26180964

RESUMO

OBJECTIVES: We examined HIV testing services, seropositivity, and the characteristics associated with newly identified, confirmed HIV-positive tests among transgender individuals. METHODS: We analyzed data (2009-2011) using bivariate and multivariable logistic regression to examine the relationships between HIV positivity and sociodemographic and risk characteristics among male-to-female transgender individuals. RESULTS: Most of the testing was conducted in females (51.1%), followed by males (48.7%) and transgender individuals (0.17%). Tests in male-to-female transgender individuals had the highest, newly identified confirmed HIV positivity (2.7%), followed by males (0.9%), female-to-male transgender individuals (0.5%), and females (0.2%). The associated characteristics with an HIV-positive test among male-to-female transgender individuals included ages 20 to 29 and 40 to 49 years (adjusted odds ratio [AOR] = 2.8; 95% confidence interval [CI] = 1.4, 5.6 and AOR = 2.8; 95% CI = 1.3, 5.9, respectively), African American (AOR = 4.6; 95% CI = 2.7, 7.9) or Hispanic/Latino (AOR = 2.6; 95% CI = 1.5, 4.5) race/ethnicity, and reporting sex without condom within the past year (AOR = 1.9; 95% CI = 1.3, 2.6), sex with an HIV-positive person (AOR = 1.5; 95% CI = 1.1, 2.0), or injection drug use (AOR = 2.0; 95% CI = 1.3, 3.0). CONCLUSIONS: High levels of HIV positivity among transgender individuals, particularly male-to-female transgender individuals, underscore the necessity for targeted HIV prevention services that are responsive to the needs of this population.


Assuntos
Infecções por HIV/diagnóstico , Pessoas Transgênero , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Porto Rico/epidemiologia , Estados Unidos/epidemiologia , Ilhas Virgens Americanas/epidemiologia
12.
Sex Transm Dis ; 42(8): 405-10, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26165428

RESUMO

BACKGROUND: Although routine human immune deficiency virus (HIV) testing during health care visits is recommended for most adults, many older adults (i.e., ages 50-64 years) do not receive it. This study identified factors associated with HIV testing in the past 12 months (i.e., recent HIV testing) among US adults in the 3 categories of older adulthood (50-54, 55-59, and 60-64 years) for which routine HIV testing is recommended. METHOD: This was a cross-sectional analysis of data from US older adult respondents to the 2010 Behavioral Risk Factor Surveillance System. We calculated prevalence (proportions) of HIV testing by age category and race/ethnicity. Using multiple logistic regression, we identified predisposing, enabling, and need factors associated with recent HIV testing within and across age categories, by race/ethnicity and controlling for covariates. RESULTS: HIV testing prevalence was low (<5%), varied by race/ethnicity, and decreased with age. Within and across age categories, the odds of testing were highest among blacks (odds ratio [OR], 3.47; 95% confidence interval [CI], 2.82-4.25) and higher among Latinos (OR, 2.06; 95% CI, 1.50-2.84) and the oldest and youngest categories of American Indians/Alaska Natives (OR, 2.48; 95% CI, 1.11-5.55; OR, 2.98; 95% CI, 1.49-5.95) than among whites. Those reporting a recent doctor visit (OR, 2.32; 95% CI, 1.92-2.74) or HIV risk behaviors (OR, 3.50; 95% CI, 2.67-4.59) had higher odds of HIV testing. CONCLUSION: Regardless of risk, the oldest older adults, whites, and older women may forego HIV testing. Doctor visits may facilitate HIV testing. Additional research is needed to understand why eligible older adults seen by providers may not be screened for HIV infection.


Assuntos
Fidelidade a Diretrizes , Infecções por HIV/diagnóstico , Programas de Rastreamento/organização & administração , Afro-Americanos , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Diagnóstico Precoce , Grupo com Ancestrais do Continente Europeu , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Comportamentos Relacionados com a Saúde , Hispano-Americanos , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Vigilância da População , Guias de Prática Clínica como Assunto , Prevalência , Assunção de Riscos , Estados Unidos/epidemiologia
13.
Public Health Rep ; 129(5): 446-54, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25177056

RESUMO

OBJECTIVES: We assessed if HIV testing and diagnoses increased during the week of National HIV Testing Day (NHTD) and if characteristics of people who were tested varied compared with control weeks. METHODS: We analyzed HIV testing data from the 2010 National HIV Prevention Program Monitoring and Evaluation system to compare NHTD week (June 24-30, 2010) with two control weeks (January 7-13, 2010, and August 12-18, 2010) for the number of HIV testing events and new HIV-positive diagnoses, by demographics and other HIV-related variables. Characteristics associated with testing during NHTD week compared with control weeks were identified using Chi-square analyses. RESULTS: In 2010, an average of 15,000 more testing events were conducted and 100 more new HIV-positive diagnoses were identified during NHTD week than during the control weeks (p<0.001). Compared with control weeks, people tested during NHTD week were significantly less likely to be aged 20-29 years and non-Hispanic white and significantly more likely to be (1) aged ≥ 50 years, (2) non-Hispanic black or African American, (3) men who have sex with men, (4) low-risk heterosexuals, (5) tested with a rapid HIV test, or (6) tested in a non-health-care setting. CONCLUSION: In 2010, CDC-funded HIV testing events and new HIV-positive diagnoses increased during NHTD week compared with control weeks. HIV testing programs increased the use of rapid tests and returned a high percentage of test results. NHTD campaigns reached populations disproportionately affected by HIV and further expanded testing to people traditionally less likely to be tested. Incorporating strategies used during NHTD in programs conducted throughout the year may assist in increasing HIV testing and the number of HIV-positive diagnoses.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/diagnóstico , Promoção da Saúde/métodos , Sorodiagnóstico da AIDS/métodos , Sorodiagnóstico da AIDS/tendências , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Homossexualidade Masculina , Humanos , Lactente , Masculino , Programas de Rastreamento/estatística & dados numéricos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Estados Unidos , Adulto Jovem
14.
J Subst Abuse Treat ; 42(2): 116-24, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22154032

RESUMO

The Institute of Medicine noted that effective substance abuse treatment (SAT) programs integrate individual therapeutic approaches with transitional/ancillary services. In addition, research suggests that type of ownership impacts SAT services offered and that Medicaid plays a key role in SAT access. Data from the National Survey of Substance Abuse Treatment Services for the years 2000 and 2002-2006 were used to examine relationships among SAT program Medicaid acceptance, program ownership, and transitional/ancillary service accessibility. Multivariate logistic regression models controlling for state- and program-level contextual factors were used to analyze the data. Nonprofit SAT programs were significantly more likely to offer transitional/ancillary services than for-profit programs. However, programs that accepted Medicaid, regardless of ownership, were significantly more likely to offer most transitional/ancillary services. The data suggest that Medicaid may play a significant role in offering key transitional/ancillary services related to successful treatment outcome, regardless of program ownership type.


Assuntos
Medicaid/economia , Propriedade/economia , Centros de Tratamento de Abuso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/terapia , Acesso aos Serviços de Saúde/economia , Humanos , Transtornos Relacionados ao Uso de Substâncias/economia , Estados Unidos
15.
J Correct Health Care ; 17(4): 294-308, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21821605

RESUMO

Adolescent substance abuse is a criminal behavior; however, not all criminal behaviors result in criminal justice involvement. This study examined disparities among adolescents aged 12 to 17 admitted to substance abuse treatment nationwide. Findings indicate significant disparities in patterns and determinants of criminal justice involvement between White and minority adolescents. Minorities were significantly more likely to be involved with the criminal justice system, even after controlling for criminal behaviors, substance abuse, mental health problems, and socioenvironmental risk. Findings reveal that connections to the educational system may be especially important for minority groups. The importance of developing systems of treatment for adolescents in the community and correctional system that are part of the same continuum of care is highlighted.


Assuntos
Grupos de Populações Continentais , Direito Penal , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Comportamento do Adolescente/etnologia , Criança , Comorbidade , Feminino , Georgia , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais , Estados Unidos
16.
J Subst Abuse Treat ; 37(2): 203-10, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19195815

RESUMO

This study examines disparities in co-occurring mental health and substance use problems by race/ethnicity to inform the development of culturally appropriate treatment approaches. Using pooled clinical data collected with the Global Assessment of Individual Needs, we identified racial/ethnic and other factors associated with co-occurring internalizing problems, externalizing problems, and the combination thereof in adolescents in federally funded treatment facilities. Results show that after controlling for demographic and socioenvironmental factors, African Americans, Hispanics, and mixed-race adolescents were more likely than Whites to have co-occurring internalizing problems. African Americans and Native Americans were less likely than Whites to have externalizing problems and to have combined internalizing and externalizing problems. Presence of co-occurring problems was also associated with victimization, homelessness, and family substance abuse. These results indicate that co-occurring mental health problems vary by race/ethnicity, and therefore, refined approaches are needed for culturally appropriate care of patients.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Transtornos Mentais/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Criança , Vítimas de Crime/psicologia , Competência Cultural , Diagnóstico Duplo (Psiquiatria) , Feminino , Jovens em Situação de Rua/psicologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etnologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Estados Unidos
17.
J Natl Med Assoc ; 100(12): 1405-16, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19110908

RESUMO

BACKGROUND: Black youth are disproportionately affected by the HIV/AIDS epidemic. This study examined disparities in patterns and determinants of sexual risk behaviors among black and white adolescents in substance abuse treatment programs. METHODS: We used pooled clinical data collected from 4,565 sexually active 12-17-year-old black (29.7%) and white (70.3%) adolescents entering outpatient and residential substance abuse treatment programs nationally. Multivariate logistic regression analyses were used to examine racial differences in patterns of sexual risk behaviors and the associations of these behaviors with demographic, socioenvironmental and psychosocial risk factors, including substance use and abuse, symptoms of mental disorders and criminal behaviors. RESULTS: Blacks were significantly more likely than whites to have had sex with multiple partners, purchased or traded sex and used substances to enhance their sexual experiences, even after adjusting for demographic, socioenvironmental and psychosocial risk factors. Substance use and abuse, internalizing symptoms and drug-related crimes were significantly associated with engaging in > or =2 sexual risk behaviors in both groups. Disparities in determinants of HIV risk were also found. For instance, male gender, single-parent custody and history of criminal justice involvement were associated with having had sex with multiple partners among blacks but not among whites. Demographic, socioenvironmental and psychosocial risk factors accounted for up to 30% of the variance in sexual risk in both groups. CONCLUSIONS: Black adolescents with substance use problems are at greater risk for HIV infection than their white peers because of their higher rates of sexual risk behaviors. Differences in co-occurring psychosocial problems did not fully explain racial disparities in sexual risk behaviors. HIV prevention programs for black adolescents in treatment should consider both individual and broader contextual factors that co-occur with sexual risk behaviors.


Assuntos
Comportamento do Adolescente , Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Adolescente , Afro-Americanos/estatística & dados numéricos , Crime/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Assunção de Riscos , Fatores Socioeconômicos , Centros de Tratamento de Abuso de Substâncias
18.
Women Health ; 46(2-3): 59-76, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18160370

RESUMO

BACKGROUND: In the United States, HIV rates are disproportionately high among black women, with 78% of cases attributed to heterosexual transmission. This analysis examined HIV testing, high risk behaviors and condom use consultation for the prevention of sexually transmitted diseases (STD) among a diverse sample of women. METHODS: Secondary analyses were conducted using data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS). This dataset included a sample of 43,550 (12% black, 79% white, and 9% Hispanic) women aged 18 to 49 years, living in the United States. Both bivariate and multivariate statistical analyses were conducted. RESULTS: Multivariate logistic regression analyses revealed that ethnic group differences existed for past-year HIV test, high-risk behaviors, and condom use consultation even after we controlled for age, education,income, employment status, and region of residence. Black women were three times more likely than white women to report a past-year HIV test and Hispanic women were 50% more likely than white women and report a past-year HIV test. Women who reported receiving condom use consultations were most likely to be Hispanic, 30 to 34 years old, and residents of the northeast. CONCLUSIONS: Initiatives to promote HIV testing appeared to have affected HIV testing behaviors among black women. However, increased HIV testing among black women was not associated with an increased likelihood of condom use counseling by a healthcare professional. More emphasis on HIV counseling is warranted to assist with HIV risk reduction and to complement HIV testing initiatives.


Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo/etnologia , Grupos Étnicos/estatística & dados numéricos , Soropositividade para HIV/diagnóstico , Soropositividade para HIV/etnologia , Saúde da Mulher/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Sistema de Vigilância de Fator de Risco Comportamental , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Nível de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Assunção de Riscos , Comportamento Sexual/etnologia , Doenças Sexualmente Transmissíveis/etnologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
19.
J Consult Clin Psychol ; 75(5): 729-38, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17907855

RESUMO

As a basis for theories of psychopathology, clinical psychology and related disciplines need sound taxonomies that are generalizable across diverse populations. To test the generalizability of a statistically derived 8-syndrome taxonomic model for youth psychopathology, confirmatory factor analyses (CFAs) were performed on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) completed by 30,243 youths 11-18 years old from 23 societies. The 8-syndrome taxonomic model met criteria for good fit to the data from each society. This was consistent with findings for the parent-completed Child Behavior Checklist (Achenbach & Rescorla, 2001) and the teacher-completed Teacher's Report Form (Achenbach & Rescorla, 2001) from many societies. Separate CFAs by gender and age group supported the 8-syndrome model for boys and girls and for younger and older youths within individual societies. The findings provide initial support for the taxonomic generalizability of the 8-syndrome model across very diverse societies, both genders, and 2 age groups.


Assuntos
Sintomas Afetivos/diagnóstico , Transtornos do Comportamento Infantil/diagnóstico , Comparação Transcultural , Inventário de Personalidade/estatística & dados numéricos , Ajustamento Social , Transtornos Somatoformes/diagnóstico , Adolescente , Sintomas Afetivos/psicologia , Criança , Transtornos do Comportamento Infantil/psicologia , Feminino , Humanos , Masculino , Modelos Estatísticos , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Transtornos Somatoformes/psicologia , Síndrome
20.
J Clin Child Adolesc Psychol ; 36(3): 405-17, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17658984

RESUMO

There is a growing need for multicultural collaboration in child mental health services, training, and research. To facilitate such collaboration, this study tested the 8-syndrome structure of the Child Behavior Checklist (CBCL) in 30 societies. Parents' CBCL ratings of 58,051 6- to 18-year-olds were subjected to confirmatory factor analyses, which were conducted separately for each society. Societies represented Asia; Africa; Australia; the Caribbean; Eastern, Western, Southern, and Northern Europe; the Middle East; and North America. Fit indices strongly supported the correlated 8-syndrome structure in each of 30 societies. The results support use of the syndromes in diverse societies.


Assuntos
Transtornos do Comportamento Infantil/diagnóstico , Comparação Transcultural , Grupos Étnicos/psicologia , Determinação da Personalidade/estatística & dados numéricos , Adolescente , Criança , Transtornos do Comportamento Infantil/psicologia , Feminino , Humanos , Masculino , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Estatística como Assunto
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