Geographic distribution of newborn HIV seroprevalence in relation to four sociodemographic variables

Individual and Neighborhood Characteristics Associated with HIV Among Black and Latino Adults Who Use Drugs and Unaware of Their HIV-Positive Status, New York City, 2000-2004

With mounting evidence of how neighborhood socioeconomic context influences individual behavior, investigation of neighborhood social context and sex/drug use risk behavior could help explain and provide insight into solutions to solve persistent racial disparities in HIV. Interviewer-administered surveys and HIV testing among street-recruited individuals who reported illicit drug use in New York City were conducted from 2000 to 2004. Individuals were geocoded to census tracts, and generalized estimating equations were used to determine correlates of being newly diagnosed with HIV at study enrollment. Analyses were completed in 2014. Of the 920 participants, 10.5 % were HIV-positive, and among those, 45 % were diagnosed at study enrollment. After restricting the sample to those who self-reported negative HIV status (n = 867), 72 % were male, 65 % Latino, and 5.1 % tested HIV-positive. After adjustment, those testing HIV-positive were more likely to report male same-sex partnership (p < 0.01) and less likely to be homeless compared with those confirmed HIV-negative (p < 0.01). Neighborhood-adjusted models indicated those from neighborhoods with less deprivation (p < 0.05), and a higher proportion of owner-occupied homes (p < 0.01) were more likely to test HIV-positive. Additionally, Black individuals who used drugs and were from neighborhoods with a higher proportion of Black residents were more likely to be newly diagnosed compared to Latino individuals who used drugs and were from neighborhoods with lower proportions of Black residents (p < 0.05). These data suggest that HIV prevention and treatment efforts should continue widening its reach to those unaware of their HIV infection, namely men who have sex with men, heavy, drug-involved Black communities, and both Black and Latino communities from relatively less disadvantaged neighborhoods.

Progress in prevention of mother-to-child transmission of HIV in New York State: 1988-2008

OBJECTIVES

To assess the outcomes of efforts to prevent mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) made over the last 2 decades in New York State (NYS), through review of data from multiple sources.

METHODS

Using available surveillance, laboratory, and program monitoring data, the following were examined for NYS: (1) the rate of prenatal HIV testing, (2) HIV prevalence among childbearing women, (3) maternal prenatal and delivery care, (4) care of HIV-exposed infants, and (5) the rate of MTCT. Trends over time and comparisons among groups were assessed.

RESULTS

In NYS, HIV prevalence in childbearing women has declined 70% since its peak in 1989. Rates of prenatal HIV testing have been more than 95% in recent years. Rates of MTCT have decreased significantly; since 2003, transmission in HIV-exposed births has ranged from 1.2% to 2.6% annually. On bivariate analysis, MTCT is more likely to occur with breastfeeding or absence of antiretroviral administration in the prenatal, labor/delivery, and newborn periods.

CONCLUSIONS

Mother-to-child HIV transmission has declined dramatically in all groups in NYS. Universal newborn screening data have provided the foundation for identifying HIV-exposed births and for initiating follow-up to track all aspects of MTCT in NYS. Remaining challenges include universal prenatal care, prevention of acquisition of HIV infection during pregnancy, and adherence to antiretroviral therapy.

Association between community socioeconomic position and HIV diagnosis rate among adults and adolescents in the United States, 2005 to 2009

OBJECTIVES

We examined the association between socioeconomic position (SEP) and HIV diagnosis rates in the United States and whether racial/ethnic disparities in diagnosis rates persist after control for SEP.

METHODS

We used cases of HIV infection among persons aged 13 years and older, diagnosed 2005 through 2009 in 37 states and reported to national HIV surveillance through June 2010, and US Census data, to examine associations between county-level SEP measures and 5-year average annual HIV diagnosis rates overall and among race/ethnicity-sex groups.

RESULTS

The HIV diagnosis rate was significantly higher for individuals in the low-SEP tertile than for those in the high-SEP tertile (rate ratios for low- vs high-SEP tertiles range = 1.68-3.38) except for White males and Hispanic females. The SEP disparities were larger for minorities than for Whites. Racial disparities persisted after we controlled for SEP, urbanicity, and percentage of population aged 20 to 50 years, and were high in the low-SEP tertile for males and in low- and high-SEP tertiles for females.

CONCLUSIONS

Findings support continued prioritization of HIV testing, prevention, and treatment to persons in economically deprived areas, and Blacks of all SEP levels.

Stigmatized drug use, sexual partner concurrency, and other sex risk network and behavior characteristics of 18- to 24-year-old youth in a high-risk neighborhood

BACKGROUND

Sex risks and drug use are related. This relation in youth is described.

GOAL

To determine how stigmatized drug use is related to sexual risk behaviors and network characteristics among youth.

STUDY DESIGN

In-person interviews were conducted with both a probability household sample (n = 363) and a targeted, street-recruited sample of cocaine, heroin, crack, or injected drug users (n - 165) comprising 18- to 24-year-olds in an inner city neighborhood. Drug use in the preceding 12 months was scaled hierarchically, lowest to highest social stigma, as none, marijuana, noninjected cocaine, noninjected heroin, crack, and injected drugs.

RESULTS

Users of the more stigmatized drugs had more sex partners. They were more likely to report a history of concurrent sex partners, sex with someone who also had engaged in sex with a network member, commercial sex work, and unprotected sex. Findings showed crack use and drug injection to be associated more strongly with increased sex risk among women than among men.

CONCLUSIONS

Young users of the more stigmatized drugs are at much greater network and behavior risk for sexually transmitted diseases. Drug use prevention, harm reduction interventions, or both may lower this risk.

Consistent condom use in the heterosexual relationships of young adults who live in a high-HIV-risk neighbourhood and do not use "hard drugs"

This study was set up to determine the predictors of condom use in the heterosexual non-commercial sexual relationships of young adults who neither inject drugs nor use cocaine, heroin or crack, in a neighbourhood with widespread drug-use-connected HIV. The analytic sample is 279 young adults, aged 18-24, who have never injected drugs and who have not used heroin, cocaine or crack in the last year. They were recruited in the Bushwick neighbourhood of New York City, July 1997 to September 1999. A face-to-face interview included items about their sociodemographic background, substance use and sexual networks. Sexual relationship and self-reported consistent (100%) condom use over the prior year with the partner in a given relationship was examined. Subjects had 337 heterosexual non-commercial relationships. Consistent condom use was reported in 32% of these relationships. In multiple logistic regression, consistent condom use was more likely in relationships that are not 'very close' (odds ratio = 3.92; 95% confidence interval = 2.08, 7.52); in the relationships of subjects whose peer norms support condom use (OR = 1.94; 95% CI = 1.43, 2.69), who are not problem drinkers (OR = 8.70; 95% CI = 2.22, 58.8), and (perhaps as a result of measurement issues) who are men (OR = 1.95; 95% CI = 1.04, 3.68). In conclusion, consistent condom use remains uncommon among youth in this high-risk neighbourhood. It is thus important to keep HIV from entering the sexual networks of youth in communities like this through programmes aimed at drug injectors and their sexual partners. Programmes to increase condom use among young adults should focus on strengthening norms that promote safer sex to protect oneself and others. In addition, assistance should be provided to youth who are problem drinkers.

Economic deprivation and AIDS incidence in Massachusetts

OBJECTIVES

This study quantified AIDS incidence in Massachusetts in relation to economic deprivation.

METHODS

Using 1990 census block-group data, 1990 census population counts, and AIDS surveillance registry data for the years 1988 through 1994, we generated yearly and cumulative AIDS incidence data for the state of Massachusetts stratified by sex and by neighborhood measures of economic position for the total, Black, Hispanic, and White populations.

RESULTS

Incidence of AIDS increased with economic deprivation, with the magnitude of these trends varying by both race/ethnicity and sex. The cumulative incidence of AIDS in the total population was nearly 7 times higher among persons in block-groups where 40% or more of the population was below the poverty line (362 per 100,000) than among persons in block-groups where less than 2% of the population was below poverty (53 per 100,000).

CONCLUSIONS

Observing patterns of disease burden in relation to neighborhood levels of economic well-being elucidates further the role of poverty as a population-level determinant of disease burden. Public health agencies and researchers can use readily available census data to describe neighborhood-level socioeconomic conditions. Such knowledge expands options for disease prevention and increases the visibility of economic inequality as an underlying cause of AIDS.

Consented testing of newborns and childbearing women for human immunodeficiency virus through a newborn metabolic screening program

OBJECTIVE

In this program a postpartum woman could consent to receive her newborn's human immunodeficiency virus test result from the New York State Newborn Screening Program.

STUDY DESIGN

By state regulation each postpartum woman was counseled and offered her newborn's human immunodeficiency virus test result. With the mother's consent, newborn human immunodeficiency virus antibody test results from the Newborn Screening Program were sent to the baby's pediatrician; otherwise, test results were blinded. Data were analyzed for births from August 1, 1996, to January 31, 1997.

RESULTS

Overall, 92.5% of women offered newborn human immunodeficiency virus testing consented to receive the result. Among 444 human immunodeficiency virus-positive women offered newborn testing, consented testing resulted in a 21.4% increase in knowledge of human immunodeficiency virus status from 72.3% (n = 321) at delivery to 93.7% (n = 416) after newborn testing; 6.3% (n = 28) of human immunodeficiency virus-positive women delivered of infants who did not consent apparently remained unaware of their human immunodeficiency virus status.

CONCLUSION

Combined prenatal and consented newborn testing identified 94% of human immunodeficiency virus-positive mothers and exposed newborns, allowing early entry into care. Such testing may provide an opportunity for women not previously tested for the human immunodeficiency virus to learn their status but is not a substitute for universal prenatal human immunodeficiency virus counseling and consented human immunodeficiency virus testing.

Problem-focused coping in HIV-infected mothers in relation to self-efficacy, uncertainty, social support, and psychological distress

A preliminary investigation of relationships among perceived self-efficacy, uncertainty, social support, psychological distress, and problem-focused coping was conducted in a convenience sample of 41 HIV-infected mothers. The mothers represented 93% of the clients in a large HIV clinic in 1992 who met the study criteria. Support was found for using Lazarus and Folkman's stress, appraisal, and coping framework to understand the health-related needs of HIV-infected mothers. Maternal coping was related to living with one's children and their HIV-status. The feasibility of studying this population of women was demonstrated. Findings suggest the need for exploration of family-focused interventions.

The treatment of non-HIV-related conditions in newborns at risk for HIV: a survey of neonatologists

OBJECTIVES

The purpose of this study was to examine attitudes of neonatologists about treatment of conditions unrelated to the human immunodeficiency virus (HIV) for critically ill newborns at risk for HIV.

METHODS

Questionnaires were mailed to the 1508 members of the Section on Perinatal Medicine of the American Academy of Pediatrics; 63% completed the survey (n = 951). The survey included structured questions about treatment for hypothetical cases and open-ended questions eliciting reasons for decisions.

RESULTS

Differences in recommendations for treatment by both maternal and infant HIV status were substantial and statistically reliable. For example, 98% of respondents recommended life-saving cardiac surgery for a neonate with no risk for HIV, but only 93% recommended such surgery for a child of an HIV-positive mother; only 50% recommended the same surgery for a newborn known to be infected. The corresponding figures for chronic dialysis were 91%, 61%, and 26%. Most expected diminished quality of life for both infected and uninfected children of HIV-positive mothers.

CONCLUSIONS

Recommendations about life-sustaining treatment for non-HIV-related conditions varied by HIV status. These data on physician attitudes raise the possibility that infants labeled as HIV positive, whether infected or not, may suffer discrimination.

Illness cognition of HIV-infected mothers

Despite the increasing prevalence of human immunodeficiency virus (HIV) infection in the female population the responses of women to their HIV-positive status and their resultant needs remain largely unexplored. This investigation explored the needs, choices, and decisions faced by 38 mothers since becoming HIV-positive. Participants were recruited from an infectious disease clinic in a large mid-Atlantic urban area. The results are based on data from taped, semistructured interviews with participants. Themes that emerged from these verbal reports illustrated that decisions and choices, uncertainty, their relationship to their children, and a renewed spirituality influenced the actions that they took in response to their HIV-positive status. Themes are discussed in relation to needs for further research and health-related interventions.

A state program for postpartum HIV counseling and testing

The New York State Department of Health began its Obstetrical HIV Counseling/Testing/Care Initiative in 1989. The objective of the initiative was to expand the availability of and access to human immunodeficiency virus (HIV) infection counseling and voluntary testing in the postpartum setting. Programs have been initiated in 24 hospitals statewide. The initiative emphasizes cooperative arrangements within participating hospitals for referring patients to medical and social services. Participation by hospitals in the initiative is voluntary. Initial grants to hospitals for the initiative ranged from $50,000 to $80,000. The main obstacle in implementing the initiative has been a lack of such resources as administrative or clinical support, phlebotomy services, and office or clinical space. During the period from August 1, 1990, through March 31, 1992, 16,436 women at risk for HIV infection were counseled in the postpartum setting at 24 hospitals participating in the initiative. Of them, 6,754 (41.1 percent) consented to HIV testing. Of the 6,754 tested, 3,000 women (44.5 percent) returned to receive test results and posttest counseling. Counseling and testing activities supported through the initiative identified 196 of 1,227 (16 percent) of the HIV-positive women who gave birth at participating hospitals and 196 of 892 (22 percent) seropositive women not previously identified. Combining testing data from the initiative with other data on seropositivity, the authors estimated that 43.3 percent of HIV-positive women delivering infants at participating hospitals were identified by voluntary testing. Hospital performance in the program varied markedly. Further study is needed to determine how to improve the effectiveness of the effort to identify HIV-positive childbearing women at the less successful hospitals and to enhance the rates of patients returning for posttest counseling and community followup.

Who won't tell: predictors of refusal to report number of sex partners

Data from 1475 respondents to a telephone survey are used to examine whether those who refused to report the number of their sex partners in the 12-month period prior to the interview are more likely to engage in HIV risk behaviours than those who did report this number. Logistic regression shows that refusal is associated with being single of low education (OR(adj) = 8.0, 95% CI 2.7-23.7), using condoms in the last year (OR(adj) = 4.2, 95% CI 1.6-11.1), self-reporting of HIV-risk behaviours (OR(adj) = 3.6, 95% CI 1.3-9.6), and being male (OR(adj) = 2.7, 95% CI 1.1-6.6). These associations apply only to a subsample of individuals who provided complete information for HIV risk and other related behaviours. Results from the total sample indicate that individuals in our study who did not report their number of partners are more likely to have characteristics that are compatible with a higher probability of HIV risk practices. This pattern of associations suggests that refusers are indeed at higher risk for HIV infection than those sexually active individuals who did report the number of partners.

Improving estimates of HIV-1 seroprevalence among childbearing women: use of smaller blood spots

OBJECTIVES

Nationwide, human immunodeficiency virus type 1 (HIV-1) seroprevalence surveys using dried neonatal blood specimens are critical to estimating HIV-1 seroprevalence among childbearing women. However, the noninclusion of blood specimens deemed "quantity not sufficient" (QNS) for HIV-1 antibody testing potentially introduces bias. In Wisconsin beginning in 1990, we modified the survey protocol to reduce QNS rates and assess bias introduced by QNS specimens.

METHODS

The HIV-1 antibody assay was modified to use four 1/8-in blood spots when a single 1/4-in blood spot could not be obtained. Both methods obtain identical blood volumes for testing.

RESULTS

During a 27-month period, 7396 (4.8%) of 154,683 specimens were deemed QNS using 1/4-in blood spots. Of these, 6590 (89%) were of sufficient quantity to be tested using four 1/8-in blood spots; 6 (0.09%) specimens tested with 1/8-in blood spots were HIV-1 Western blot assay positive compared with 44 (0.03%) of 147,287 1/4-in specimens (odds ratio = 3.0; 95% confidence interval = 1.2, 7.4).

CONCLUSIONS

Because noninclusion of QNS specimens potentially introduces bias, incorporating the results of HIV-1 antibody testing of QNS specimens using four 1/8-in blood spots can improve the accuracy of HIV-1 seroprevalence estimates in these serologic surveys.