HIV-seropositive, active injection-drug users (IDUs), compared with other HIV populations, continue to have low rates of highly active antiretroviral therapy (HAART) use, contributing to disparities in their HIV health outcomes. We sought to identify individual-level, interpersonal, and structural factors associated with HAART use among active IDUs to inform comprehensive, contextually tailored intervention to improve the HAART use of IDUs. Prospective data from three semiannual assessments were combined, and logistic general estimating equations were used to identify variables associated with taking HAART 6 months later. Participants were a community sample of HIV-seropositive, active IDUs enrolled in the INSPIRE study, a U.S. multisite (Baltimore, Miami, New York, San Francisco) prevention intervention. The analytic sample included 1,225 observations, and comprised 62% males, 75% active drug users, 75% non-Hispanic blacks, and 55% with a CD4 count <350; 48% reported HAART use. Adjusted analyses indicated that the later HAART use of IDUs was independently predicted by patient-provider engagement, stable housing, medical coverage, and more HIV primary care visits. Significant individual factors included not currently using drugs and a positive attitude about HAART benefits even if using illicit drugs. Those who reported patient-centered interactions with their HIV primary care provider had a 45% greater odds of later HAART use, and those with stable housing had twofold greater odds. These findings suggest that interventions to improve the HIV treatment of IDUs and to reduce their HIV health disparities should be comprehensive, promoting better patient-provider engagement, stable housing, HAART education with regard to illicit drug use, and integration of drug-abuse treatment with HIV primary care.

Active injection drug users (IDUs) are at high risk of unsuccessful highly active antiretroviral therapy (HAART). We sought to identify baseline factors differentiating IDUs' treatment success versus treatment failure over time among those taking HAART. Interventions for Seropositive Injectors-Research and Evaluation (INSPIRE) study participants were assessed at baseline and at 6- and 12-month follow-ups. Multinominal regression determined baseline predictors of achieving or maintaining viral suppression relative to maintaining detectable viral loads over 12 months. Of 199 participants who were retained and remained on HAART, 133 (67%) had viral load change patterns included in the analysis. At follow-up, 66% maintained detectable viral loads and 15% achieved and 19% maintained viral suppression. Results indicated that those having informal care (instrumental or emotional support) were 4.6 times more likely to achieve or maintain viral suppression relative to experiencing treatment failure. Those who maintained viral suppression were 3.5 times less likely to live alone or to report social discomfort in taking HAART. Study results underscore the importance of microsocial factors of social network support, social isolation, and social stigma for successful HAART outcomes among IDUs. The findings suggest that adherence interventions for IDUs should promote existing informal HIV caregiving, living with supportive others, and positive medication-taking norms among social networks.

This cross- sectional study examined factors associated with the receipt of HIV medical care among people who know their HIV status and are not newly diagnosed with HIV. Interviews were conducted with 1133 HIV- positive individuals between October 2003 and July 2005 who enrolled in 1 of 10 outreach programs across the country. The sample was predominantly non-white ( 86%), male ( 59%), and unstably housed ( 61%), with a past history of cocaine use ( 68%). Twelve percent had received no HIV medical care in the 6 months prior to the interview. Those with no care were similar to those who received some HIV care in sociodemographic characteristics, but in multivariate analysis were less likely to have a case manager ( p < 0.001) or use mental health services ( p < .001), had lower mental health status scores ( p < 0.05), were more likely to be active drug users ( p < 0.01), had greater unmet support service needs ( p < 0.05) and reported that health beliefs were a barrier to care ( p < 0.001). Interventions to engage people in HIV medical care need to address barriers to care through linkages with mental health, substance abuse treatment and support services, and address the health beliefs that deter people from seeking care.

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.

Background: Many persons with HIV infection do not receive consistent ambulatory medical care and are excluded from studies of patients in medical care. However, these hard-to-reach groups are important to study because they may be in greatest need of services.Objective: This study compared the sociodemographic, clinical, and health care utilization characteristics of a multisite sample of HIV-positive persons who were hard to reach with a nationally representative cohort of persons with HIV infection who were receiving care from known HIV providers in the United States and examined whether the independent correlates of low ambulatory utilization differed between the 2 samples.Methods: We compared sociodemographic, clinical, and health care utilization characteristics in 2 samples of adults with HIV infection: 1286 persons from 16 sites across the United States interviewed in 2001-2002 for the Targeted HIV Outreach and Intervention Initiative (Outreach), a study of underserved persons targeted for supportive outreach services; and 2267 persons from the HIV Costs and Services Utilization Study (HCSUS), a probability sample of persons receiving care who were interviewed in 1998. We conducted logistic regression analyses to identify differences between the 2 samples in sociodemographic and clinical associations with ambulatory medical visits.Results: Compared with the HCSUS sample, the Outreach sample had notably greater proportions of black respondents (59% vs. 32%, P = 0.0001), Hispanics (20% vs. 16%), Spanish-speakers (9% vs. 2%, P = 0.02), those with low socioeconomic status (annual income <$10,000 75% vs. 45%, P = 0.0001), the unemployed, and persons with homelessness, no insurance, and heroin or cocaine use (58% vs. 47%, P = 0.05). They also were more likely to have fewer than 2 ambulatory visits (26% vs. 16%, P = 0.0001), more likely to have emergency room visits or hospitalizations in the prior 6 months, and less likely to be on antiretroviral treatment (82% vs. 58%, P = 0.0001). Nearly all these differences persisted after stratifying for level of ambulatory utilization (fewer than 2 vs. 2 or more in the last 6 months). In multivariate analysis, several variables showed significantly different associations in the 2 samples (interacted) with low ambulatory care utilization. The variables with significant interactions (P values for interaction shown below) had very different adjusted odds ratios (and 95% confidence intervals) for low ambulatory care utilization: age greater than 50 (Outreach 0.55 [0.350.88], HCSUS 1.17 [0.65-2.11)], P = 0.05), Hispanic ethnicity (Outreach 0.81 [0.39-1.69], HCSUS 2.34 [1.56-3.52], P = 0.02), low income (Outreach 0.73 [0.56-0.96], HCSUS 1.35 [1.04-1.75], P = 0.002), and heavy alcohol use (Outreach 1.74 [1.23-2.45], HCSUS 1.00 [0.73-1.37], P = 0.02). Having CD4 count less than 50 was associated with elevated odds of low ambulatory medical visits in the Outreach sample (1.53 [1.00-2.36], P = 0.05).Conclusions: Compared with HCSUS, the Outreach sample had far greater proportions of traditionally vulnerable groups, and were less likely to be in care if they had low CD4 counts. Furthermore, heavy alcohol use was only associated with low ambulatory utilization in Outreach. Generalizing from in care populations may not be warranted, while addressing heavy alcohol use may be effective at improving utilization of care for hard-to-reach HIV-positive populations.

Summary: Among individuals receiving highly active antiretroviral therapy (HAART), injection drug users (IDUs) are less likely to achieve HIV suppression. The present study examined individual-level, interpersonal, and structural factors associated with achieving undetectable plasma viral load (UVL) among US IDUs receiving recommended HAART. Data were from baseline assessments of the INSPIRE (Interventions for Seropositive Injectors-Research and Evaluation) study, a 4-site, secondary HIV prevention intervention for heterosexually active IDUs. Of 1113 study participants at baseline, 42% (n = 466) were currently taking recommended HAART (34% were female, 69% non-Hispanic black, 26% recently homeless; median age was 43 years), of whom 132 (28%) had a UVL. Logistic regression revealed that among those on recommended HAART, adjusted odds of UVL were at least 3 times higher among those with high social support, stable housing, and CD4 > 200; UVL was approximately 60% higher among those reporting better patient-provider communication. Outpatient drug treatment and non-Hispanic black race and an interaction between current drug use and social support were marginally negatively significant. Among those with high perceived support, noncurrent drug users compared with current drug users had a greater likelihood of UVL; current drug use was not associated with UVL among those with low support. Depressive symptoms (Brief Symptom Inventory) were not significant. Results suggest the major role of social support in facilitating effective HAART use in this population and suggest that active drug use may interfere with HAART use by adversely affecting social support. Interventions promoting social support functioning, patient-provider communication, stable housing, and drug abuse treatment may facilitate effective HAART use in this vulnerable population.

Pharmacotherapy for substance abuse is a rapidly evolving field comprising both old and new effective treatments for substance use. Opiate agonist therapy has been shown to diminish and often eliminate opiate use. This behavior change has resulted in the reduced transmission of many infections, including HIV, hepatitis C virus (HCV), and an enhanced quality of life. For the past 35 years, the provision of opioid agonist therapy has been limited to opioid treatment programmes. Opioid treatment programmes treat approximately 200 000 of the estimated million opiate-addicted individuals in the United States. With the need to increase the number of treatment opportunities available for opioid-dependent patients, Congress passed the Drug Addiction Treatment Act of 2000, which allows for the treatment of opioid dependence using buprenorphine by a properly licensed physician, including HIV primary care physicians. The integration of buprenorphine treatment for opioid addiction into HIV primary care thus provides a new treatment paradigm to address substance abuse in patients with HIV and HCV infections.

Introduction to the Special Supplement: Prevention With Persons Living With HIVMonica L. Baskin, Ronald L. Braithwaite, Lois Eldred and Marlene GlassmanMonica L. Baskin1. University of Alabama at BirminghamSearch for more papers by this author, Ronald L. Braithwaite2. Morehouse School of MedicineSearch for more papers by this author, Lois Eldred3. Health Resources and Services Administration, Rockville, MDSearch for more papers by this author and Marlene Glassman4. Centers for Disease Control and Prevention, Atlanta, GASearch for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/aeap.17.2.1.58698PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutReferencesCenters for Disease Control and Prevention. (2003). Advancing HIV Prevention: New Strategies for a Changing Epidemic—United States, 2003. Morbidity and Mortality Weekly Report, 52(15), 329–332. Medline, Google ScholarCenters for Disease Control and Prevention. (2004, May). Advancing HIV Prevention (AHP) Initiative, executive summary: Progress fact sheet, April 2003–April 2004. Atlanta, GA: Author. Google ScholarKalichman , S.C., Rompa, D., Cage, M., DiFonzo, K., Simpson, D., Austin, J., Luke, W., Buckles, J., Kyomugisha, F., Benotsch, E., Pinkerton, S., & Grahoam, J. (2001). Effectiveness of an intervention to reduce HIV transmission risks in HIV–positive people. American Journal of Preventive Medicine, 21(2), 84–92. Crossref Medline, Google Scholar Next article FiguresReferencesRelatedDetails Cited byCited by1. Self-health care behaviors and knowledge of youth living with HIVOnline publication date: Go to citation Crossref Google Scholar2. Reduced Sexual Risk Behaviors Among People Living with HIV: Results from the Healthy Relationships Outcome Monitoring ProjectOnline publication date: 9 March 2011. Go to citation Crossref Google Scholar3. Discussion of Sexual Risk Behavior in HIV Care is Infrequent and Appears Ineffectual: A Mixed Methods StudyOnline publication date: 28 October 2010. Go to citation Crossref Google Scholar4. HIV Medical Care Provider Practices for Reducing High-Risk Sexual Behavior: Results of a Qualitative StudyOnline publication date: Go to citation Crossref Google Scholar5. Processes and Outcomes of HIV Serostatus Disclosure to Sexual Partners among People Living with HIV in UgandaOnline publication date: 8 September 2007. Go to citation Crossref Google Scholar6. Evolution of the Special Projects of National Significance Prevention with HIV-Infected Persons Seen in Primary Care Settings InitiativeOnline publication date: 2 June 2007. Go to citation Crossref Google Scholar7. Religiosity, Denominational Affiliation, and Sexual Behaviors Among People With HIV in the United StatesOnline publication date: Go to citation Crossref Google Scholar8. Perceptions of Health and Self-Care Learning Needs of Outpatients With HIV/AIDSOnline publication date: Go to citation Crossref Google Scholar9. Religiosity, Denominational Affiliation, and Sexual Behaviors Among People With HIV in the United StatesOnline publication date: Go to citation Crossref Google Scholar Volume 17Issue supplement_aFeb 2005 Information© by The Guilford PressPDF download

Objectives Ancillary services have been associated with beneficial health utilization outcomes among individuals infected with the human immunodeficiency virus (HIV), including greater retention in medical care and greater likelihood of antiretroviral use. Our primary objectives were to examine gender differences in barriers to ancillary services among people living with HIV in the Southeastern United States. Methods Survey and chart abstraction data were collected from six tertiary infectious diseases clinics in the Southeast. Using multivariate analyses, we examined the relationship between gender and 1) knowledge of how to access HIV and acquired immunodeficiency syndrome (AIDS) resource information and 2) opinions about the helpfulness of local services for people with HIV/AIDS. Results Women were less knowledgeable about HIV/AIDS resources and rated local services less favorably than men. Middle-aged and older African-American women rated local services as less helpful than other survey participants did. Conclusions These findings indicate a need for outreach services that are designed to address the specific needs of older African-American women, and women in general.

We examined a quality improvement (QI) program, offered to ambulatory care clinics (N = 82) serving human immunodeficiency virus-positive clients, to determine what factors predicted the clinic independently implementing QI processes without their program consultant's help. Initial analyses examined clinics at 4 levels of involvement: withdrew from the project, initial QI proficiency, advanced QI proficiency, and consultant independent. The initial and advanced stages were collapsed into 1 group (consultant dependent) and compared with consultant-independent clinics for multivariate logistic regression. In the multivariate models, 3 factors significantly predicted the clinic being consultant independent: staffing level (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.2-2.2), the number of participating months (OR = 1.4, 95% CI = 1.0-2.0), and baseline QI readiness (OR = 1.1, 95% CI = 1.0-1.3). Receiver operator curves were calculated for significant predictors; the strongest predictor was staffing (c statistic = .79). Clinics that are organizationally prepared for QI, allow adequate time to adopt QI methods into their organization, and provide adequate QI staffing are more likely to independently apply QI methods.

PURPOSE: To examine associations of systemic and ocular characteristics with severity of cytomegalovirus (CMV) retinitis at time of diagnosis and to compare ocular characteristics of eyes with and without CMV retinitis.METHODS: Eleven clinical centers, a data coordinating center, and a fundus photograph reading center participated in a randomized, controlled, multicenter clinical trial comparing foscarnet and ganciclovir as primary therapy for previously untreated CMV retinitis in 240 patients with AIDS.RESULTS: The systemic characteristics marginally associated with the percentage of retina affect ed by CMV in a patient's worse eye at diagnosis were chronic fever, weight loss, and number of HIV-related illnesses. A positive CMV blood culture at diagnosis was similarly associated with bilateral disease. Laboratory measures of disease did not correlate well with measures of CMV retinitis severity. Many eyes with CMV retinitis had no or minimal lesion hemorrhage, but most had signs of inflammation. Patients often reported visual symptoms for involved eyes. The worse eyes (the eye with lesions covering the most retinal area) of patients with bilateral disease had greater retinal involvement, more lesions, and fewer degrees of visual field than did involved eyes of patients with unilateral disease. Visual symptoms, inflammation, indolent retinitis, and hemorrhagic lesions were associated with a greater percentage of retina affected by CMV.CONCLUSIONS: The findings support viremia as a mechanism of spread for untreated disease. Visual symptoms and signs of ocular inflammation were indicators both of the presence of CMV retinitis and of greater extent of retinal area covered by CMV retinitis lesions.

Abstract Women account for a growing proportion of HIV infection in the United States as injection drug use and heterosexual contact become the predominant modes of HIV transmission. In seroprevalence studies of inner-city populations, the female-to-male ratio of HIV seropositivity approaches 1:1. In 1991, 74% of reported AIDS cases in women were among African-American and Hispanic women.AIDS is the fourth leading cause of death among women of childbear ing age nationallyand the leading cause of death among women of childbearing age in several urban areas. Recognition of early manifestations of HIV disease in women is essential for the initiation of antiretroviral and chemoprophylactic therapy since the effective ness and tolerance of many therapeutic regimens diminishes with advanced HIV disease.Until recently, however, manifestations of HIV that may be unique to, or more prevalent in, women have not been studied. The primary focus of research in HIV-infected women has been vertical transmission, examining rates of transmission of HIV from mother to child during pregnancy. Frequently, HIV infection in women is identified through routine prenatal screening in areas of high HIV infection, where a majority of women are unaware of exposure to HIV.7 Despite the high prevalence of gynecological manifestations in women, HIV infection often remains undiagnosed until advanced immunodeficiency is present since clinicians may not suspect HIV when women present with gynecological complications.

Gallant, J. E.; Eldred, L. J.; Leslie, J. M.; Chaisson, R. E.; Quinn, T. C. Author Information