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1.
AIDS ; 32(14): 2075-2076, 2018 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-29912059

RESUMO

: Discrimination in healthcare settings is a barrier to healthcare engagement. We analyzed two nationally representative datasets to assess change in discrimination in healthcare settings reported by HIV patients from 1996 to 2011-2013. Perceived discrimination in healthcare settings significantly decreased over time, from 24% in 1996 to 15% in 2011-2013. Improvements over time in HIV clinicians' engagement in prevention discussions with patients following federal agencies' recommendations may have been a contributing factor.


Assuntos
Gerenciamento Clínico , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Instalações de Saúde , Discriminação Social/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
2.
J Acquir Immune Defic Syndr ; 76(5): 445-452, 2017 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-28902072

RESUMO

BACKGROUND: In the United States (US), foreign-born persons are disproportionately affected by HIV and differ epidemiologically from US-born persons with diagnosed HIV infection. Understanding HIV transmission dynamics among foreign-born persons is important to guide HIV prevention efforts for these populations. We conducted molecular transmission network analysis to describe HIV transmission dynamics among foreign-born persons with diagnosed HIV. METHODS: Using HIV-1 polymerase nucleotide sequences reported to the US National HIV Surveillance System for persons with diagnosed HIV infection during 2001-2013, we constructed a genetic distance-based transmission network using HIV-TRACE and examined the birth region of potential transmission partners in this network. RESULTS: Of 77,686 people, 12,064 (16%) were foreign born. Overall, 28% of foreign-born persons linked to at least one other person in the transmission network. Of potential transmission partners, 62% were born in the United States, 31% were born in the same region as the foreign-born person, and 7% were born in another region of the world. Most transmission partners of male foreign-born persons (63%) were born in the United States, whereas most transmission partners of female foreign-borns (57%) were born in their same world region. DISCUSSION: These finding suggests that a majority of HIV infections among foreign-born persons in our network occurred after immigrating to the United States. Efforts to prevent HIV infection among foreign-born persons in the United States should include information of the transmission networks in which these individuals acquire or transmit HIV to develop more targeted HIV prevention interventions.


Assuntos
Emigrantes e Imigrantes , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Adolescente , Adulto , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
3.
Int J STD AIDS ; 27(13): 1162-1169, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-26464501

RESUMO

Hispanic immigrant/migrant men who have sex with men (MSM) should be at higher risk for sexually transmitted infections/human immunodeficiency virus (STIs/HIV) given individual-level factors associated with the migration process that have been theorised to increase susceptibility to STIs/HIV among migrant populations. However, relatively little is known if these individual level factors are actually associated with the STI prevalence among this population. During 2005-2007, 2576 men and women foreign-born Hispanics were surveyed at three community-based organisations offering services to immigrant/migrant communities in the US. We analysed demographic characteristics, sexual risk behaviours, migration patterns, and factors associated with STI diagnoses (syphilis, chlamydia, and gonorrhoea) in the past 12 months among Hispanic immigrant/migrant MSM. Of 1482 Hispanic immigrant/migrant men surveyed who reported having sex in the past 12 months, 353 (24%) reported sex with a man, and of these, 302 answered questions regarding whether or not they had been diagnosed with a bacterial STI in the past year. Of these 302 men, 25% reported being married; 42% self-identified as being heterosexual and 20% as bisexual. Twenty-nine (9.6%) men reported that they had received an STI diagnosis in the past year. In the multivariate logistic regression model, men who reported receiving money or goods for sex had increased odds of a self-reported STI diagnosis. The prevalence of bacterial STIs among Hispanic immigrant/migrant MSM is lower than the prevalence of bacterial STIs among other MSM in the United States. Nevertheless, receiving money or goods for sex was significantly associated with a self-reported STI diagnosis among Hispanic immigrant/migrant MSM. It is important to understand factors contributing to participation in exchange sex among this population. HIV/STI prevention interventions tailored to non-gay identifying MSM are important for Hispanic immigrant/migrant MSM.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Gonorreia/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Análise Multivariada , Assunção de Riscos , Doenças Sexualmente Transmissíveis/etnologia , Fatores Socioeconômicos , Inquéritos e Questionários , Sífilis/epidemiologia , Estados Unidos , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 64(39): 1097-103, 2015 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-26448539

RESUMO

Hispanics or Latinos represent about 17% of the total U.S. population and are disproportionately affected by human immunodeficiency virus (HIV) infection in the United States. In 2013, the rate of HIV diagnosis among Hispanics or Latinos (18.7) was nearly three times that of non-Hispanic whites (6.6). To better characterize HIV infection among Hispanics or Latinos aged ≥13 years in the United States, CDC analyzed data from the National HIV Surveillance System (NHSS). During 2008-2013, the rate of diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased from 28.3 per 100,000 population in 2008 to 24.3 in 2013 (estimated annual percentage change [EAPC] = -3.6); however, the number of diagnoses among males with infection attributed to male-to-male sexual contact increased 16%, from 6,141 in 2008 to 7,098 in 2013 (EAPC = 3.0). In 2013, the rate of diagnosis of HIV infection among males (41.3) was six times the rate among females (6.8). During 2008-2013, behavioral risk factors for HIV infection among Hispanics or Latino differed among males and females and by place of birth. Among Hispanic or Latino males born in Puerto Rico, the proportion of HIV infections attributed to injection drug use (24.9%) was greater than among those born elsewhere. Among HIV-infected Hispanic or Latino females, those born in the United States (21.2%) and Puerto Rico (20.5%) had a greater proportion of HIV infections attributed to injection drug use than those born elsewhere. Additional interventions and public health strategies to further decrease the rates of HIV among the Hispanic or Latino population are needed.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Vigilância da População , Adolescente , Adulto , Idoso , Feminino , Heterossexualidade/etnologia , Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Características de Residência/estatística & dados numéricos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
5.
Sex Transm Dis ; 42(4): 171-9, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25763669

RESUMO

BACKGROUND: Bacterial sexually transmitted infections may facilitate HIV transmission. Bacterial sexually transmitted infection testing is recommended for sexually active HIV-infected patients annually and more frequently for those at elevated sexual risk. We estimated percentages of HIV-infected patients in the United States receiving at least one syphilis, gonorrhea, or chlamydia test, and repeat (≥2 tests, ≥3 months apart) tests for any of these sexually transmitted infections from mid-2008 through mid-2010. DESIGN: The Medical Monitoring Project collects behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States using nationally representative sampling. METHODS: Sexual activity included self-reported oral, vaginal, or anal sex in the past 12 months. Participants reporting more than 1 sexual partner or illicit drug use before/during sex in the past year were classified as having elevated sexual risk. Among participants with only 1 sex partner and no drug use before/during sex, those reporting consistent condom use were classified as low risk; those reporting sex without a condom (or for whom this was unknown) were classified as at elevated sexual risk only if they considered their sex partner to be a casual partner, or if their partner was HIV-negative or partner HIV status was unknown. Bacterial sexually transmitted infection testing was ascertained through medical record abstraction. RESULTS: Among sexually active patients, 55% were tested at least once in 12 months for syphilis, whereas 23% and 24% received at least one gonorrhea and chlamydia test, respectively. Syphilis testing did not vary by sex/sexual orientation. Receipt of at least 3 CD4+ T-lymphocyte cell counts and/or HIV viral load tests in 12 months was associated with syphilis testing in men who have sex with men (MSM), men who have sex with women only, and women. Chlamydia testing was significantly higher in sexually active women (30%) compared with men who have sex with women only (19%), but not compared with MSM (22%). Forty-six percent of MSM were at elevated sexual risk; 26% of these MSM received repeat syphilis testing, whereas repeat testing for gonorrhea and chlamydia was only 7% for each infection. CONCLUSIONS: Bacterial sexually transmitted infection testing among sexually active HIV-infected patients was low, particularly for those at elevated sexual risk. Patient encounters in which CD4+ T-lymphocyte cell counts and/or HIV viral load testing occurs present opportunities for increased bacterial sexually transmitted infection testing.


Assuntos
Infecções por HIV/etiologia , Programas de Rastreamento , Comportamento Sexual , Doenças Bacterianas Sexualmente Transmissíveis/etiologia , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Contagem de Linfócito CD4/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Humanos , Masculino , Pesquisa Qualitativa , Sistemas de Alerta , Assunção de Riscos , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle , Doenças Bacterianas Sexualmente Transmissíveis/psicologia , Estados Unidos/epidemiologia , Carga Viral/estatística & dados numéricos
6.
J Int Assoc Provid AIDS Care ; 14(3): 245-54, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25394912

RESUMO

OBJECTIVES: Guidelines for antiretroviral therapy (ART) initiation have evolved, but consistently note that adherence problems should be considered and addressed. Little is known regarding the reasons providers delay ART initiation in clinically eligible patients. METHODS: In 2009, we surveyed a probability sample of HIV care providers in 582 outpatient facilities in the United States and Puerto Rico with an open-ended question about nonclinical reasons for delaying ART initiation in otherwise clinically eligible patients. RESULTS: Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART. CONCLUSION: Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Cooperação do Paciente , Médicos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos , Adulto Jovem
7.
J Immigr Minor Health ; 17(6): 1826-33, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25403987

RESUMO

In 2011, Hispanic immigrant women comprised 44% of HIV diagnoses among Hispanic women in the United States but little is known about factors that may place these women at risk for infection with HIV or sexually transmitted diseases. From March 2005 to February 2007, women were recruited at community-based organizations offering services to immigrant and migrant communities in five U.S. states. We report factors independently associated with unprotected anal and vaginal sex in the past 12 months among Hispanic immigrant and migrant women. Greater work-related mobility was associated with unprotected anal sex, while recency of immigration and prior refusal of HIV testing were associated with women's reports of unprotected vaginal sex. Prior sex with an injection drug user was associated with reports of both unprotected anal and vaginal sex. Findings highlight the need for HIV/STD risk reduction interventions designed specifically for Hispanic immigrant and migrant women.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Parceiros Sexuais , Migrantes/estatística & dados numéricos , Sexo sem Proteção/etnologia , Adolescente , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Assunção de Riscos , Comportamento Sexual/etnologia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/etnologia , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
8.
AIDS ; 28(8): 1203-11, 2014 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-25000558

RESUMO

OBJECTIVE: To describe the prevalence and association of sexual risk behaviours and viral suppression among HIV-infected adults in the United States. DESIGN: Cross-sectional analysis of weighted data from a probability sample of HIV-infected adults receiving outpatient medical care. The facility and patient response rates were 76 and 51%, respectively. METHODS: We analysed 2009 interview and medical record data. Sexual behaviours were self-reported in the past 12 months. Viral suppression was defined as all viral load measurements in the medical record during the past 12 months less than 200 copies/ml. RESULTS: An estimated 98 022 (24%) HIV-infected adults engaged in unprotected vaginal or anal sex; 50 953 (12%) engaged in unprotected vaginal or anal sex with at least one partner of negative or unknown HIV status; 23 933 (6%) did so while not virally suppressed. Persons who were virally suppressed were less likely than persons who were not suppressed to engage in vaginal or anal sex [prevalence ratio, 0.88; 95% confidence interval (CI), 0.82-0.93]; unprotected vaginal or anal sex (prevalence ratio, 0.85; 95% CI, 0.73-0.98); and unprotected vaginal or anal sex with a partner of negative or unknown HIV status (prevalence ratio, 0.79; 95% CI, 0.64-0.99). CONCLUSION: The majority of HIV-infected adults receiving medical care in the U.S. did not engage in sexual risk behaviours that have the potential to transmit HIV, and of the 12% who did, approximately half were not virally suppressed. Persons who were virally suppressed were less likely than persons who were not suppressed to engage in sexual risk behaviours.


Assuntos
Infecções por HIV/epidemiologia , Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , HIV-1 , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prevalência , RNA Viral , Autorrelato , Estados Unidos/epidemiologia , Carga Viral , Adulto Jovem
9.
MMWR Suppl ; 63(5): 1-22, 2014 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-24941443

RESUMO

PROBLEM: As of December 31, 2009, an estimated 864,748 persons were living with human immunodeficiency virus (HIV) infection in the 50 U.S. states, the District of Columbia, and six U.S.-dependent areas. Whereas HIV surveillance programs in the United States collect information about persons with a diagnosis of HIV infection, supplemental surveillance systems collect in-depth information about the behavioral and clinical characteristics of persons receiving outpatient medical care for HIV infection. These data are needed to reduce HIV-related morbidity and mortality and HIV transmission. REPORTING PERIOD COVERED: Data were collected during June 2009-May 2010 for patients receiving medical care at least once during January-April 2009. DESCRIPTION OF THE SYSTEM: The Medical Monitoring Project (MMP) is an ongoing surveillance system that assesses behaviors and clinical characteristics of HIV-infected persons who have received outpatient medical care. For the 2009 data collection cycle, participants must have been aged ≥18 years and have received medical care during January-April 2009 at sampled facilities that provide HIV medical care within participating MMP project areas. Behavioral and selected clinical data were collected using an in-person interview, and most clinical data were collected using medical record abstraction. A total of 23 project areas in 16 states and Puerto Rico were funded to collect data during the 2009 data collection cycle. The data were weighted for probability of selection and nonresponse to be representative of adults receiving outpatient medical care for HIV infection in the United States and Puerto Rico. Prevalence estimates are presented as weighted percentages. The period of reference is the 12 months before the patient interview unless otherwise noted. RESULTS: The patients in MMP represent 421,186 adults who received outpatient medical care for HIV infection in the United States and Puerto Rico during January-April 2009. Of adults who received medical care for HIV infection, an estimated 71.2% were male, 27.2% were female, and 1.6% were transgender. An estimated 41.4% were black or African American, 34.6% were white, and 19.1% were Hispanic or Latino. The largest proportion (23.1%) were aged 45-49 years. Most patients (81.1%) had medical coverage; 40.3% had Medicaid, 30.6% had private health insurance, and 25.7% had Medicare. An estimated 69.6% of patients had three or more documented CD4+ T-lymphocyte cell (CD4+) or HIV viral load tests. Most patients (88.7%) were prescribed antiretroviral therapy (ART), and 71.6% had a documented viral load that was undetectable or ≤200 copies/mL at their most recent test. Among sexually active patients, 55.0% had documentation in the medical record of being tested for syphilis, 23.2% for gonorrhea, and 23.9% for chlamydia. Noninjection drugs were used for nonmedical purposes by an estimated 27.1% of patients, whereas injection drugs were used for nonmedical purposes by 2.1% of patients. Overall, 12.9% of patients engaged in unprotected sex with a partner of negative or unknown HIV status. Unmet supportive service needs were prevalent, with an estimated 22.8% in need of dental care and 12.0% in need of public benefits, including Social Security Income or Social Security Disability Insurance. Fewer than half of patients (44.8%) reported receiving HIV and sexually transmitted disease prevention counseling from a health-care provider. INTERPRETATION: The findings in this report indicate that most adults living with HIV who received medical care in 2009 were taking ART, had CD4+ and HIV viral load testing at regular intervals, and had health insurance or other coverage. However, some patients did not receive clinical services and treatment in accordance with guidelines. Some patients engaged in behaviors, such as unprotected sex, that increase the risk for transmitting HIV to sex partners, and some used noninjection or injection drugs or both. PUBLIC HEALTH ACTIONS: Local and state health departments and federal agencies can use MMP data for program planning to determine allocation of services and resources, guide prevention planning, assess unmet medical and supportive service needs, inform health-care providers, and help focus intervention programs and health policies at the local, state, and national levels.


Assuntos
Assistência Ambulatorial , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Vigilância da População , Adolescente , Adulto , Idoso , Assistência Ambulatorial/normas , Antirretrovirais/uso terapêutico , Sistema de Vigilância de Fator de Risco Comportamental , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Porto Rico/epidemiologia , Pesquisa Qualitativa , Assunção de Riscos , Comportamento Sexual , Estados Unidos/epidemiologia , Carga Viral , Adulto Jovem
10.
AIDS ; 28(3): 407-15, 2014 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-24056066

RESUMO

OBJECTIVE: Guidelines recommend risk-reduction counseling by HIV providers to all HIV-infected persons. Among HIV-infected adults receiving medical care in the United States, we estimated prevalence of exposure to three types of HIV/sexually transmitted disease (STD) risk-reduction interventions and described the characteristics of persons who received these interventions. DESIGN: Data were from the Medical Monitoring Project (MMP), a supplemental HIV surveillance system designed to produce nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States. METHODS: Descriptive analyses were conducted to estimate the exposure to each type of HIV/STD risk-reduction intervention. Bivariate and multivariable analyses were conducted to assess associations between the selected correlates with each exposure variable. RESULTS: About 44% of participants reported a one-on-one conversation with a healthcare provider about HIV/STD prevention, 30% with a prevention program worker, 16% reported participation in a small group risk-reduction intervention, and 52% reported receiving at least one of the three interventions in the past 12 months. Minority race/ethnicity, low income, and risky sexual behavior consistently predicted greater intervention exposure. However, 39% of persons who reported risky sex did not receive any HIV/STD risk-reduction interventions. CONCLUSIONS: HIV-infected persons in care with fewer resources or those who engaged in risk behaviors were more likely to receive HIV/STD risk-reduction interventions. However, less than half of HIV-infected persons in care received HIV/STD prevention counseling from their provider, an intervention that has been shown to be effective and is supported by guidelines.


Assuntos
Aconselhamento , Transmissão de Doença Infecciosa/prevenção & controle , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Educação em Saúde , Adolescente , Adulto , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento de Redução do Risco , Estados Unidos , Adulto Jovem
11.
Public Health Rep ; 128(2): 117-26, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23450876

RESUMO

OBJECTIVE: Clinical interventions that lengthen life after HIV infection and significantly reduce transmission could have greater impact if more HIV-diagnosed people received HIV care. We tested a surveillance-based approach to investigating reasons for delayed entry to care. METHODS: Health department staff in three states and two cities contacted eligible adults diagnosed with HIV four to 24 months previously who had no reported CD4+ lymphocyte (CD4) or viral load (VL) tests. The staff conducted interviews, performed CD4 and VL testing, and provided referrals to HIV medical care. Reported CD4 and VL tests were prospectively monitored to determine if respondents had entered care after the interview. RESULTS: Surveillance-based follow-up uncovered problems with reporting CD4 and VL tests, resulting in surveillance improvements. However, reporting problems led to misspent effort locating people who were already in care. Follow-up proved difficult because contact information in surveillance case records was often outdated or incorrect. Of those reached, 37% were in care and 29% refused participation. Information from 132 people interviewed generated ideas for service improvements, such as emphasizing the benefits of early initiation of HIV care, providing coverage eligibility information soon after diagnosis, and leveraging other medical appointments to provide assistance with linkage to HIV care. CONCLUSIONS: Surveillance-based follow-up of HIV-diagnosed individuals not linked to care provided information to improve both surveillance and linkage services, but was inefficient because of difficulties identifying, locating, and recruiting eligible people. Inefficiencies attributable to missing, incomplete, or inaccurate surveillance records are likely to diminish as data quality is improved through ongoing use.


Assuntos
Infecções por HIV/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Demografia , Feminino , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Indiana/epidemiologia , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , Cidade de Nova Iorque/epidemiologia , Philadelphia/epidemiologia , Vigilância da População , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Índice de Gravidade de Doença , Washington/epidemiologia , Adulto Jovem
12.
PLoS One ; 8(1): e51231, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23341880

RESUMO

In 2006, CDC recommended HIV screening as part of routine medical care for all persons aged 13-64 years. We examined adherence to the recommendations among a sample of HIV care providers in the US to determine if known providers of HIV care are offering routine HIV testing in outpatient settings. Data were from the CDC's Medical Monitoring Project Provider Survey, administered to physicians, nurse practitioners and physician assistants from June-September 2009. We assessed bivariate associations between testing behaviors and provider and practice characteristics and used multivariate regression to determine factors associated with offering HIV screening to all patients aged 13-64 years. Sixty percent of providers reported offering HIV screening to all patients 13 to 64 years of age. Being a nurse practitioner (aOR = 5.6, 95% CI = 2.6-11.9) compared to physician, age<39 (aOR = 1.9, 95% CI = 1.0-3.5) or 39-49 (aOR = 2.1, 95% CI = 1.4-3.3) compared with ≥50 years, and black race (aOR = 2.6, 95% CI = 1.2-6.0) compared with white race was associated with offering testing to all patients. Providers with low (aOR = 0.2, 95% CI = 0.1-0.3) or medium (aOR = 0.4, 95% CI = 0.2-0.6) HIV-infected patient loads were less likely to offer HIV testing to all patients compared with providers with high patient loads. Many providers of HIV care are still conducting risk-based rather than routine testing. We found that provider profession, age, race, and HIV-infected patient load were associated with offering HIV testing. Health care providers should use patient encounters as an opportunity to offer routine HIV testing to patients as outlined in CDC's revised recommendations for HIV testing in health care settings.


Assuntos
Testes Diagnósticos de Rotina/métodos , Infecções por HIV/diagnóstico , Pessoal de Saúde , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
13.
Subst Use Misuse ; 47(5): 522-34, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22428820

RESUMO

This paper presents a qualitative investigation of peer mentoring among HIV seropositive injection drug users in a randomized controlled trial, the INSPIRE study. Qualitative analyses of 68 in-depth open-ended interviews conducted in 2005 in Baltimore, New York, Miami, and San Francisco revealed that these individuals conceptualized themselves as change agents through the identity of peer mentor at the three related domains of individual, interpersonal, and community-level change. Implications for program development and future research of peer mentoring as a mechanism for HIV prevention are discussed. This study was funded by the Centers for Disease Control and Prevention and Health Resources and Services Administration (HRSA).


Assuntos
Usuários de Drogas , Infecções por HIV/prevenção & controle , Soropositividade para HIV , Mentores , Grupo Associado , Abuso de Substâncias por Via Intravenosa , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoimagem , Apoio Social , Estados Unidos , População Urbana
14.
AIDS Patient Care STDS ; 26(4): 214-21, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22320266

RESUMO

Early entry to HIV care and receipt of antiretroviral therapy improve the health of the individual and decrease the risk of transmission in the community. To increase the limited information on prospective decisions to enter care and how these decisions relate to beliefs about HIV medications, we analyzed interview data from the Never in Care Project, a multisite project conducted in Indiana, New Jersey, New York City, Philadelphia, and Washington State. From March 2008 through August 2010, we completed structured interviews with 134 persons with no evidence of HIV care entry, 48 of whom also completed qualitative interviews. Many respondents believed that HIV care entails the passive receipt of medications that may be harmful or unnecessary, resulting in reluctance to enter care. Respondents voiced concerns about prescription practices and preserving future treatment options, mistrust of medications and medical care providers, and ambivalence about the life-preserving properties of medications in light of an assumed negative impact on quality of life. Our results support the provision of information on other benefits of care (beyond medications), elicitation of concerns about medications, and assessment of psychosocial barriers to entering care. These tasks should begin at the time a positive test result is delivered and continue throughout the linkage-to-care process; for persons unwilling to enter care immediately, support should be provided in nonmedical settings.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Soropositividade para HIV/tratamento farmacológico , Cooperação do Paciente , Adolescente , Adulto , Feminino , Fidelidade a Diretrizes , Soropositividade para HIV/psicologia , Humanos , Masculino , Cooperação do Paciente/estatística & dados numéricos , Satisfação do Paciente , Encaminhamento e Consulta , Estados Unidos , Adulto Jovem
15.
AIDS Educ Prev ; 23(3 Suppl): 117-27, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21689042

RESUMO

The HIV counseling, testing, and referral (CTR) encounter represents an important opportunity to actively facilitate entry into medical care for those who test positive for HIV, but its potential is not always realized. Ways to improve facilitation of linkage to care through the CTR encounter haven't been explored among HIV-infected persons who have not entered care. We conducted 42 structured and qualitative interviews among HIV-infected persons, diagnosed 5-19 months previously, in Indiana, Philadelphia and Washington State, who had not received HIV medical care. Respondents related individual and system-level barriers, as well as recommendations for improving the effectiveness of CTR as a facilitator of linkage to HIV medical care through more active referrals, and for strengthening the bridge between CTR and linkage to care services. Our findings suggest that standards for active case referral by CTR staff and integration of CTR and linkage to care services are needed.


Assuntos
Infecções por HIV/psicologia , Satisfação do Paciente , Encaminhamento e Consulta , Adulto , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Aconselhamento , Feminino , Fidelidade a Diretrizes , Infecções por HIV/diagnóstico , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Encaminhamento e Consulta/estatística & dados numéricos , Estados Unidos , Adulto Jovem
16.
AIDS Behav ; 15(7): 1520-6, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20099017

RESUMO

Depression contributes to worse general and HIV-related clinical outcomes. We examined the prevalence of and factors associated with depressive symptomatology among HIV-infected crack cocaine users recruited for Project HOPE (Hospital Visit is an Opportunity for Prevention and Engagement with HIV-positive Crack Users). We used multiple logistic regression to determine sociodemographic correlates associated with screening in for depression. Among 291 participants, three-quarters (73.5%) were identified as depressed. Higher odds of screening in for depression was associated with food insufficiency and monthly income below $600. Alcohol and crack use were not associated with screening in for depression. Depressive symptomatology is extremely prevalent among HIV-infected crack cocaine users and is associated with food insufficiency and lower income. Screening for depression and food insecurity should be included in HIV prevention and treatment programs. Improved recognition and mitigation of these conditions will help alleviate their contribution to HIV-related adverse health outcomes.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína Crack/efeitos adversos , Abastecimento de Alimentos/estatística & dados numéricos , Infecções por HIV/complicações , Fome , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Feminino , Florida/epidemiologia , Georgia/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Pacientes Internados , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores Socioeconômicos , População Urbana , Carga Viral
17.
AIDS Patient Care STDS ; 23(7): 551-6, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19530955

RESUMO

We have limited information regarding the sexual risk behaviors of HIV-positive individuals in Argentina. It is important to understand these behaviors in order to develop strategies oriented at decreasing unsafe sex practices. A random sample of 140 HIV-positive individuals was recruited from an HIV primary care clinic in Buenos Aires, Argentina, between August and September 2005. Participants responded survey questions regarding their sexual behaviors in the previous three months. Logistic regression analysis was used to determine factors associated with inconsistent condom use during vaginal, anal, and oral sex. Of the 140 participants surveyed, 69% were male, the mean age was 38 years old, 29% reported having less than a high school education, and 84% reported having engaged in vaginal, anal, and/or oral sex in the past 3 months. Of 53 participants who reported engaging in anal sex, 60% were men who have sex with men, and 40% were heterosexuals. Inconsistent condom use was reported by 31% of participants engaging in anal sex, 39% of participants engaging in vaginal sex, and 71% of participants engaging in oral sex. When adjusting for other factors, participants reporting symptoms of depression were 5.2 times more likely to use condoms inconsistently during vaginal sex, and 4.3 times more likely to use condoms inconsistently during anal sex compared to participants reporting no depression symptoms. Providers should assess sexual risk practices of HIV-positive individuals reporting symptoms of depression, and provide counseling regarding the importance of consistent condom use to those patients who are engaging in unsafe sex practices.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Assunção de Riscos , Comportamento Sexual , Adulto , Argentina/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , HIV-1 , Heterossexualidade , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/transmissão , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
18.
J Acquir Immune Defic Syndr ; 46 Suppl 2: S101-9, 2007 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18089979

RESUMO

Intimate partner violence (IPV) against women is a serious public health and social problem and is associated with a host of adverse health outcomes and behaviors, HIV risk behaviors included, among women who are victimized. Historically, research has focused on correlates of IPV victimization among women; thus, there is less information on the role of men in perpetrating IPV, particularly among men at risk for transmitting HIV to their female partners. We assessed the self-reported prevalence and correlates of perpetration and threat of perpetration of physical and/or sexual IPV against a main female partner among 317 HIV-positive men who were current injection drug users (IDUs). More than 40% of men reported perpetrating physical (39%) and/or sexual (4%) violence against their main female partners in the past year. Multivariate analyses revealed that low education, homelessness, psychologic distress, and unprotected sex with main and nonmain HIV-negative female partners were positively associated with IPV perpetration against main female partners. These findings reveal that IPV perpetration is prevalent among HIV-positive male IDUs and associated with sexual HIV transmission risk behaviors. IPV assessment and treatment among HIV-positive men in HIV care is recommended as a way to prevent IPV perpetration and victimization and to reduce potential HIV transmission.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Delitos Sexuais/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Adolescente , Adulto , Coleta de Dados/métodos , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Assunção de Riscos , Autorrevelação , Estados Unidos/epidemiologia
19.
J Acquir Immune Defic Syndr ; 46 Suppl 2: S35-47, 2007 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18089983

RESUMO

BACKGROUND: There is a lack of effective behavioral interventions for HIV-positive injection drug users (IDUs). We sought to evaluate the efficacy of an intervention to reduce sexual and injection transmission risk behaviors and to increase utilization of medical care and adherence to HIV medications among this population. METHODS: HIV-positive IDUs (n=966) recruited in 4 US cities were randomly assigned to a 10-session peer mentoring intervention or to an 8-session video discussion intervention (control condition). Participants completed audio computer-assisted self-interviews and had their blood drawn to measure CD4 cell count and viral load at baseline and at 3-month (no blood), 6-month, and 12-month follow-ups. RESULTS: Overall retention rates for randomized participants were 87%, 83%, and 85% at 3, 6, and 12 months, respectively. Participants in both conditions reported significant reductions from baseline in injection and sexual transmission risk behaviors, but there were no significant differences between conditions. Participants in both conditions reported no change in medical care and adherence, and there were no significant differences between conditions. CONCLUSIONS: Both interventions led to decreases in risk behaviors but no changes in medical outcomes. The characteristics of the trial that may have contributed to these results are examined, and directions for future research are identified.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Acesso aos Serviços de Saúde , Cooperação do Paciente , Abuso de Substâncias por Via Intravenosa , Adulto , Controle Comportamental/métodos , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Resultado do Tratamento , Estados Unidos/epidemiologia , Carga Viral
20.
J Acquir Immune Defic Syndr ; 46 Suppl 2: S55-63, 2007 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18089985

RESUMO

HIV-positive injection drug users (IDUs) are at risk for transmitting HIV to their sex and injection partners, and compared with non-IDUs, they have poorer access to medical care and adherence to antiretroviral therapies. Social support has been linked with decreased injection and sexual risk behaviors and slower disease progression. In this qualitative process evaluation, we explored emotional support (ie, caring, empathy), informational support (ie, information, guidance, feedback), and appraisal support (ie, information for self-evaluation or understanding) received by participants in the Interventions for Seropositive Injectors-Research and Evaluation (INSPIRE) project, a multisite secondary prevention intervention for HIV-positive IDUs. Participants in the intervention and control conditions (N=40) described similar experiences in terms of type, source, and perceived benefits of social support received from the program. Emotional support was received from program staff, other participants, and elements of the intervention. Participants also mentioned social support received from the INSPIRE project in relation to changes they had made in their lives during and after their involvement in the intervention, such as changes in their drug use, sexual practices, and health care utilization.


Assuntos
Infecções por HIV/psicologia , Apoio Social , Abuso de Substâncias por Via Intravenosa/complicações , Controle Comportamental/métodos , Coleta de Dados/métodos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Masculino , Fatores de Risco , Autorrevelação , Estados Unidos/epidemiologia
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