Opportunities to improve prevention and services for HIV-infected women in nonurban Alabama and Mississippi

Women, economic hardship and the path of survival: HIV/AIDS risk behavior among women receiving HIV/AIDS treatment in Uganda

The results are presented from a 2005 survey of 377 women in four HIV/AIDS treatment programs in Uganda. The aim of the study was to explore women's economic hardships and the association with four sexual risk behaviors: whether a woman was sexually active in the last 12 months, whether a condom was used during the last sex act, whether she reported having had a sexual partner in the last six months who she suspected had multiple partners and report of forced, coercive or survival sex in the last six months. Few women were sexually active (34%), likely due to the high proportion of widows (49%). Married women were likely to report forced, coercive or survival sex (35%). Eighty-four percent of women reported condom used at last sex act. Forced, coercive or survival sex was associated with number of meals missed per week (AOR=1.125, 95% CI 1.11, 1.587, p<0.05). Sex with a partner in the last six months who a woman suspected had multiple partners was also associated with number of missed meals per week (AOR=2.080, 95% CI 1.084, 3.992). Currently women in Ugandan antiretroviral therapy programs are not likely to be sexually active, except for married women. Many women need to find food and other support, which may put them at risk of forced, coercive or survival sex due to dependency on men.

Drugs, incarceration, and HIV/AIDS among African American men: a critical literature review and call to action

Incarceration and HIV/AIDS disproportionately affect African American men compared to the U.S. population as a whole. Disparities in relation to crime and HIV/AIDS for Black men suggest that these phenomena have elements in common, particularly given the mediating role of illicit drug use or drug activities in both cases. A socioecological exploration of how and why these twin epidemics intersect (and the role of drug-related activities as mediating variables) is needed illicit drug use or to address the impact of these epidemics on the health and well-being of communities of color. This article critically reviews relevant articles, research reports, and official statistics, as well as conceptual frames of reference for information on the socioecological synergies between crime, drugs, and HIV/AIDS. The article recommends five calls for action for policies to mitigate the cumulative negative effects of these epidemics and for interventions to enhance the life chances of at-risk Black men.

Migration patterns following HIV diagnosis among adults residing in the nonurban Deep South

Health care needs of those infected with the human immunodeficiency virus (HIV) and subsequent transmission dynamics are altered by migration after infection. We interviewed 760 HIV-infected persons attending HIV-specialty clinics living in non-urban Alabama and Mississippi to ascertain the likely geographic origins of their infections, determine their post-HIV diagnosis mobility, and identify predictors of this mobility. Most subjects (81%) were living in these two states when diagnosed and have not moved since learning of their HIV status (70%). Of those who moved their primary residence post-HIV diagnosis (25% of the entire study population), the majority in-migrated to Alabama or Mississippi from elsewhere. Persons who had moved post-HIV diagnosis were more likely to be male, an injection drug user, an urban resident at HIV diagnosis, have an AIDS-defining condition, and have moved prior to HIV diagnosis. We conclude that most HIV transmission in non-urban Alabama and Mississippi is acquired locally. These results underline the need to expand HIV prevention programs in the Deep South.

Increasing AIDS case reports in the South: U.S. trends from 1981–2004

This study compares the trends in AIDS case reports in Southern states and in other regions and estimates the factors associated with the trends. Data from the HIV/AIDS Surveillance Reports 1999 and 2004 of the Centers for Disease Control and Prevention were used to calculate the proportion of the total cumulative cases (1981-2004) that occurred in the five most recent years (2000-2004). A linear regression model was fitted to estimate the factors associated with the highest recent growth rate for AIDS cases by state. Results revealed that Southern states (including the District of Columbia) are more likely to have a disproportionate proportion of total AIDS cases reported within the past five years (25.5% in 16 states and the District) compared to the rest of the U.S. (mean = 19.3% in 34 states and Puerto Rico and the U.S. Virgin Islands; p < 0.001). Being a southern state (4.3% higher in proportion; 95% CI, 1.3%-7.3%) and higher representation of black race (0.1%, 95% CI, 0.02%-0.2%) were factor independently associated with higher recent growth rate for a state. AIDS case rates suggest recent worrisome trends in the South. Those states and territories that are in the South and that have higher proportions of African-Americans have a higher proportion of recent AIDS case reports than elsewhere, suggesting the need for a special geographic focus to encourage prevention, HIV testing, and access to care.

Life changing words: women's responses to being diagnosed with HIV infection

In this longitudinal study, we investigated the diagnosis experiences of 55 human immuno-deficiency virus (HIV)-infected women. Women's immediate reactions upon hearing that they were infected with HIV were devastation, shock, and indignation. Long-term responses included depression, submersion of the HIV infection diagnosis, escalated drug and alcohol use, shame, and suicidality. It was usually months and sometimes years before women could extricate themselves from these patterns of response. It is critical to make HIV infection diagnosis the first intervention in a protocol of seamless support that sees women through the initial trauma of being diagnosed until longer term primary care and social services can be activated.

Delayed access to HIV diagnosis and care: Special concerns for the Southern United States

HIV diagnosis and presentation to appropriate medical care during early stages of disease has substantial clinical and public health benefits. However, a large proportion of HIV-infected Americans experience diagnosis and treatment related delays. Prior research evaluating barriers to early HIV diagnosis and care presentation have been published primarily from large East and West coast urban centers. Therefore, predictors of delayed presentation to HIV care identified by these studies may not be generalizable to the South where infected persons are increasingly non-white, female, poor, non-urban, and possibly exposed to HIV heterosexually. We review here the benefits conferred by HIV care, descriptive epidemiology of delayed HIV diagnosis and care, and potential barriers to early medical care with special reference to conditions prevalent in the South.

Adherence to HAART among HIV-infected persons in rural Louisiana

The purpose of this study was to examine factors associated with nonadherence to highly active antiretroviral therapy (HAART) in patients seen in HIV clinics throughout nonurban Louisiana. A convenience sample of 273 patients from 8 areas in nonurban Louisiana were interviewed to obtain demographic, clinical and adherence information. Associations between demographic, clinical, and behavioral factors and nonadherence were examined. Ideally, non-adherence should not exceed 5% in patients for whom HAART was prescribed. Mean age was 38.6 years (range, 19-66), 29.3% were female, 60.1% were African American, 34.4% reported nonadherence to their HAART medication (defined as the subject's self-report of missing any doses of HAART medication in the prior week). In the prior month, participants reported the following behaviors: binge drinking (12.8%), problem drinking (12.8%), and illicit drug use (16.5%). Depression was found in 49.8% of the respondents. In logistic regression analysis, problem drinking odds ratio [OR] (95% confidence interval [CI]): 3.92 (1.69,9.09) was found to be associated with nonadherence. Demographic and behavioral factors such as illicit drug use and depression were not associated with nonadherence on multivariable analysis. Problem drinking was associated with lack of adherence to HAART over the past week. Interventions to treat problem drinking are needed and may improve adherence to medication for HIV-infected persons living in rural, town, and small-city areas.