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

Krawczyk, Christopher; Funkhouser, Ellen; Kilby, J. Michael; Vermund, Sten H.

doi:10.1080/09540120600839280

Cited by 57 publications

(56 citation statements)

References 57 publications

(64 reference statements)

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“…Prior studies have demonstrated an association between not having insurance or being underinsured and delaying entry into HIV medical care. 10,11,14,18,[38][39][40] The underlying reasons why HIV-positive patients are not accessing Medicaid (in California known as Medi-Cal), Ryan Whitefunded clinics, or other public clinics or coverage mechanisms (e.g., AIDS Drug Assistance Program [ADAP]) need to be determined. Although these services were available in the regions where study participants were interviewed, there may be factors other than eligibility that are driving low utilization of available insurance programs or services designed for uninsured persons.…”

Section: Discussionmentioning

confidence: 99%

“…8 In one of the earliest studies of delayed entry into HIV care, Samet et al 9 found that 89% of HIV-positive persons in Massachusetts and Rhode Island delayed care for more than 1 year. In Alabama, 34% of HIV-positive persons delayed care for more than 1 year following diagnosis 10 and a study using a nationally representative sample found that 17-29% of HIVpositive persons delayed care for more than 3 months, with a median delay of 1 year. 11 Other studies looking at median time from HIV diagnosis to care initiation show delays ranging from 33 days to 8 months.…”

Section: Introductionmentioning

confidence: 99%

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A Community-Based Study of Barriers to HIV Care Initiation

Pollini

Blanco

Crump

et al. 2011

AIDS Patient Care and STDs

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Timely treatment of HIV infection is a public health priority, yet many HIV-positive persons delay treatment initiation. We conducted a community-based study comparing HIV-positive persons who received an HIV diagnosis at least 3 months ago but had not initiated care (n = 100) with a reference population of HIV-positive persons currently in care (n = 115) to identify potential barriers to treatment initiation. Study participants were mostly male (78.0%), and persons of color (54.9% Latino, 26.3% black), with median age 37.8 years. Median time since HIV diagnosis was 3.7 years. Univariate analysis revealed that those never in care differed substantially from those currently in care with regard to sociodemographics; HIV testing and counseling experiences; perceived barriers to care; and knowledge, attitudes, and beliefs regarding HIV. , and not wanting to think about being HIV positive (AOR = 3.57; 95% CI: 1.22, 10.46). Our findings suggest that isolation and stigma remain significant barriers to initiating HIV care in populations consisting primarily of persons of color, and that direct linkages to HIV care at the time of diagnosis are critical to promoting timely care initiation in these populations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Community-Based Study of Barriers to HIV Care Initiation

Pollini

Blanco

Crump

et al. 2011

AIDS Patient Care and STDs

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show abstract

“…A literatura internacional cita obstáculos ao acesso à atenção em saúde vivenciados por pessoas vivendo com HIV/AIDS, entre eles: desigualdades sócio-econômicas 11,17,18,19,20,21 disparidades étnicas e de gênero 9,19,20,21,22 , disponibilidade de recursos sociais e financeiros 18,20,21,23 , barreiras geográficas, diferenças culturais entre profissionais de saúde e usuários 19 , receio ou vivência real de estigma 18,19,21,24 .…”

Section: Acquired Immunodeficiency Syndrome; Health Services Accessibunclassified

“…O acesso a serviço de saúde resulta da interação complexa de fatores individuais, sociais e organizacionais 12,14,16,20,21,24,27 . Evidências trazidas pelo presente estudo reforçam esse dado ao indicarem que oferecer atendimento no Serviço de Atenção à AIDS de Salvador não garante necessariamente o acesso dos usuários à assistência.…”

Section: Conclusãounclassified

Acesso universal? Obstáculos ao acesso, continuidade do uso e gênero em um serviço especializado em HIV/AIDS em Salvador, Bahia, Brasil

Oliveira

2009

Cad. Saúde Pública

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Desde 1996, o Brasil mantém políticas internacionalmente conhecidas como de acesso universal ao tratamento especializado em HIV/AIDS. Observa-se, que o impacto da iniciativa tem sido desigual entre diferentes populações e regiões brasileiras. Desde uma perspectiva de gênero, o estudo buscou avaliar o acesso a um serviço especializado em HIV/AIDS localizado em Salvador, Bahia, identificando fatores facilitadores e obstaculizadores ao acesso e continuidade do uso vivenciados por mulheres vivendo com HIV/AIDS. Foram realizadas observação participante e entrevistas semi e não estruturadas com 13 usuárias. Resultados indicaram que a organização das rotinas do serviço e as relações travadas entre usuários e entre eles e trabalhadores em saúde condicionavam-se por valores, concepções e práticas associados a gênero, classe e aparência. O acesso e continuidade do uso no Serviço de Atenção à AIDS de Salvador eram condicionados à disponibilidade de bens sociais e simbólicos; o serviço apresentava capacidade limitada de adequação às especificidades dos usuários. Os achados apontam para limitações da operacionalização das políticas de acesso universal; e reforçam a necessidade de estudos que considerem a noção de vulnerabilidade e regionalização da epidemia no Brasil.

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“…People living with HIV/AIDS from the Deep South are predominantly African-American, have low levels of education, live in poverty, lack health insurance and have acquired HIV infection through heterosexual contact (Reif, Geonnotti, & Whetten, 2006;. The male:female ratio tends to be more balanced and the social climate for both genders is generally one of stigma, embarrassment and fear, which, together with distrust of the healthcare system, pose substantial barriers to accessing healthcare (Krawczyk et al, 2006;Lichtenstein, 2004;Lichtenstein et al, 2005). The Deep South is also home to comparatively more groups experiencing health inequities (Minority Health Initiatives, 2006; and has a long and persistent history of disparities based on gender and economic class (Collins, 2000;Royster et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Reasons for ART non-adherence in the Deep South: Adherence needs of a sample of HIV-positive patients in Mississippi

et al. 2007

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HIV prevalence in the American Deep South has reached crisis proportions and greater numbers of patients are enrolling in clinical care and beginning antiretroviral therapy (ART). In order to gain maximum benefit from ART, patients must sustain high levels of adherence to demanding regimens over extended periods of time. Many patients are unable to maintain high rates of adherence and may need assistance to do so, which may be based upon an understanding of barriers to adherence for a given population. The current study sought to gain understanding of barriers to adherence for a mixed urban/rural HIV-positive patient population in Mississippi and to determine whether barriers to adherence may be specific to gender, employment, depressive symptoms or educational attainment status. Seventy-two patients who missed a dose of ART medication over the last three days endorsed the top five reasons for missing a dose as: (1) not having the medication with them, (2) sleeping through the dose time, (3) running out of the medication, (4) being busy with other things and (5) other. Reported barriers were fairly consistent across different groups, although women and those classified as having moderate to severe depressive symptoms reported different patterns of adherence barriers. Results suggest that adherence interventions implemented in the Deep South must take into account specific barriers faced by individuals within this region, where stigma, gender disparities and limited resources are prevalent.

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

Cited by 57 publications

References 57 publications

A Community-Based Study of Barriers to HIV Care Initiation

A Community-Based Study of Barriers to HIV Care Initiation

Acesso universal? Obstáculos ao acesso, continuidade do uso e gênero em um serviço especializado em HIV/AIDS em Salvador, Bahia, Brasil

Reasons for ART non-adherence in the Deep South: Adherence needs of a sample of HIV-positive patients in Mississippi

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