Access to HIV services by the urban poor

Understanding people who have never received HIV medical care: a population-based approach

A substantial number of people living with human immunodeficiency virus (HIV) have never received HIV medical care despite the benefits of early entry to care. The United States has no population-based system that can be used to estimate the number of people who have never received HIV care or to monitor the reasons that care is delayed. Although local efforts to describe unmet need and barriers to care have been informative, nationally representative data are needed to increase the number of people who enter care soon after diagnosis. Legal requirements to report all CD4 counts and all HIV viral load levels (indicators of HIV care) in most states now make national estimates of both care entry and non-entry feasible. The Centers for Disease Control and Prevention (CDC) and five state and local health department jurisdictions are testing and evaluating methods for a standardized supplemental HIV surveillance system to characterize HIV-infected people across the U.S. who have not entered HIV care after their diagnosis. This article reviews the context, rationale, and potential contributions of a nationally representative surveillance system to monitor delays in receiving HIV care, and provides data from the formative phase of the CDC pilot project.

HIV/AIDS prevention in New York City: identifying sociocultural needs of the community

New York City has always been and remains at the epicenter of the country's AIDS epidemic, with more than 100,000 people living with HIV/AIDS. More than Los Angeles, San Francisco, and Miami combined (CDC, 2007b). Each year there may be as many as 4,800 people in New York City who are newly diagnosed with HIV and 1,700 who die from the disease (NYC Commission on HIV/AIDS, 2005; NYC AIDS Institute, 2006g). Recent research indicates that these HIV infection rates are actually significantly higher (perhaps by as much as 40%), with the "virus spreading in NY at three times the national rate" making it evident that HIV education and prevention efforts are not effectively reaching New Yorkers (Altman, 2008, p. 1). This article reports on the findings of a quantitative study (n = 98) that sought to identify the unique sociocultural needs of NYC residents who seek HIV/AIDS care. Key questions were aimed at who gets HIV tested and why, what HIV education services were reported as most effective, and identifying the unique sociocultural obstacles to getting HIV tested. Some of the statistically significant findings include: (1) the most helpful HIV education was found to be support groups and the second most helpful was reading material offered in community based settings; (2) most residents choose to get tested under the direct advice of a physician; (3) Latinos tend to hold more HIV/AIDS Stigma than their African-American counterparts. Culturally competent implications are provided for policy, program development and direct care for those providing HIV education services in urban communities.

Late entry into HIV/AIDS medical care: the importance of past relationships with medical providers

Data are presented from a qualitative study that explored the impact of relationships with medical providers on late entry into HIV/AIDS medical care. In-depth interviews were conducted with ten males living on the US-Mexico border who entered medical care late in the progression of HIV. The findings focus on past relationships with medical providers and the perception of risk on both the part of the medical provider and the study participant. Current policy and programmatic trends and recommendations are discussed.

Theoretical and methodological issues in conducting research related to health care utilization among individuals with HIV infection

Although empirical information on resource use during HIV infection is vital to improving quality of care, the issues involved in conducting research on resource use have received little attention in the medical literature. The purpose of this paper is to review the theoretical and methodological issues of conducting research on health care utilization patterns among persons with HIV/AIDS. Conceptual definitions of utilization are compared and contrasted. Three theoretical frameworks, the Andersen Behavioral Model, the Health Belief Model, and the Biopsychosocial Model are described to illustrate their applicability in future research studies. Research designs, measurement considerations, sampling approaches, and existing data sources on utilization are reviewed. Recommendations for health care utilization research are summarized and highlight the importance of designing studies and generating data for investigation of the factors facilitating patients' use of an optimal array of services including prevention, long-term, and rehabilitation care.