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Lee YC, Chao JK, Shi MD, Ma MC, Chao IC. HCV and HIV Infection among Heroin Abusers in a Methadone Maintenance Treatment Program. Health (London) 2016. [DOI: 10.4236/health.2016.812124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Knowlton AR, Mitchell MM, Robinson AC, Nguyen TQ, Isenberg S, Denison J. Informal HIV Caregiver Proxy Reports of Care Recipients' Treatment Adherence: Relationship Factors Associated with Concordance with Recipients' Viral Suppression. AIDS Behav 2015; 19:2123-9. [PMID: 26036463 DOI: 10.1007/s10461-015-1092-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To explore the role of informal caregivers in adherence, we compared adherence reports by caregivers to those of care recipients. We identified individual-level and relationship factors associated with agreement between caregivers' reports of recipients' adherence and assessed viral suppression. Participants were care recipients, who were on ART and had ever injected drugs, and their caregivers (N = 258 dyads). Nearly three-fourths of caregivers' reports of recipients' ART adherence agreed with recipients' viral suppression status. Agreement was associated with recipient age and expressing affection or gratitude to the caregiver, caregiver's having been close to someone who died of HIV/AIDS, and caregiver's fear of caregiving-related HIV (re)infection, while it was negatively associated with recipient's limited physical functioning. Our findings support the utility of caregiver proxy reports of care recipients' ART adherence and suggest ways to identify and promote HIV caregiver attention to and support of this vulnerable population's ART adherence.
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Affiliation(s)
- Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA.
| | - Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Allysha C Robinson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Trang Q Nguyen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Sarina Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Julie Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
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Merighi JR, Chassler D, Lundgren L, Inniss HW. Substance use, sexual identity, and health care provider use in men who have sex with men. Subst Use Misuse 2011; 46:452-9. [PMID: 20735201 DOI: 10.3109/10826084.2010.502208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article describes the association between substance use, sexual identity, and seeing a health care provider on a regular basis for 257 men who have sex with men (MSM). Data from in-person interviews were gathered from MSM who resided in Massachusetts between 2003 and 2007. A logistic regression analysis that controlled for demographic characteristics, health insurance status, HIV/AIDS status, drug use, and social support revealed that MSM who identified as heterosexual, compared with those who identified as gay or bisexual, were 60% less likely to access a health care provider on a regular basis. Further, the likelihood of seeing a provider regularly was 54% lower for MSM who had used illegal drugs in the past 30 days and 32% higher for MSM who had more social support. Study limitations and implications are discussed.
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Affiliation(s)
- Joseph R Merighi
- School of Social Work, Boston University, Boston, Massachusetts 02215, USA.
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In the Shadow of Academic Medical Centers: A Systematic Review of Urban Health Research in Baltimore City. J Community Health 2010; 35:433-52. [PMID: 20422444 DOI: 10.1007/s10900-010-9258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thanh DC, Moland KM, Fylkesnes K. The context of HIV risk behaviours among HIV-positive injection drug users in Viet Nam: moving toward effective harm reduction. BMC Public Health 2009; 9:98. [PMID: 19348681 PMCID: PMC2676271 DOI: 10.1186/1471-2458-9-98] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 04/06/2009] [Indexed: 12/01/2022] Open
Abstract
Background Injection drug users represent the largest proportion of all HIV reported cases in Viet Nam. This study aimed to explore the perceptions of risk and risk behaviours among HIV-positive injection drug users, and their experiences related to safe injection and safe sex practices. Methods This study used multiple qualitative methods in data collection including in-depth interviews, focus group discussions and participant observation with HIV-positive injection drug users. Results The informants described a change in the sharing practices among injection drug users towards more precautions and what was considered 'low risk sharing', like sharing among seroconcordant partners and borrowing rather than lending. However risky practices like re-use of injection equipment and 'syringe pulling' i.e. the use of left-over drugs in particular, were frequently described and observed. Needle and syringe distribution programmes were in place but carrying needles and syringes and particularly drugs could result in being arrested and fined. Fear of rejection and of loss of intimacy made disclosure difficult and was perceived as a major obstacle for condom use among recently diagnosed HIV infected individuals. Conclusion HIV-positive injection drug users continue to practice HIV risk behaviours. The anti-drug law and the police crack-down policy appeared as critical factors hampering ongoing prevention efforts with needle and syringe distribution programmes in Viet Nam. Drastic policy measures are needed to reduce the very high HIV prevalence among injection drug users.
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Affiliation(s)
- Duong Cong Thanh
- Centre for International Health, University of Bergen, Bergen, Norway.
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Moody AL, Morgello S, Gerits P, Byrd D. Vulnerabilities and caregiving in an ethnically diverse HIV-infected population. AIDS Behav 2009; 13:337-47. [PMID: 17876698 PMCID: PMC3815540 DOI: 10.1007/s10461-007-9310-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 08/17/2007] [Indexed: 10/22/2022]
Abstract
The current study aimed to identify the primary informal caregivers of a group of urban HIV+ adults (n = 250) and to determine relationships between demographic, medical, and substance use characteristics and caregivers types. Reported caregiver types included 36.8% familial, 22.4% significant other, and 22.8% institutional or other caregiver relationships. The remaining 18% of the sample reported having no individual that rendered informal care. Factors associated with the absence of an informal caregiver included African American race and low education. Hispanic participants reported the highest frequency of family caregivers while participants with a history of substance disorder were less likely to identify a significant other as a caregiver. This study demonstrates the evolving nature of informal caregiving in HIV, race- and education-related disparities in the absence of primary caregivers, and the importance of sociocultural and demographic factors in the study of HIV caregiving.
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Affiliation(s)
- Anissa L. Moody
- Department of Pathology, Mt Sinai School of Medicine, New York, NY, USA; Manhattan HIV Brain Bank, Mt. Sinai School of Medicine, One Gustave Levy Place, Box 1134, New York, NY 10029, USA
| | - Susan Morgello
- Department of Pathology, Mt Sinai School of Medicine, New York, NY, USA; Manhattan HIV Brain Bank, Mt. Sinai School of Medicine, One Gustave Levy Place, Box 1134, New York, NY 10029, USA
| | - Pieter Gerits
- Department of Pathology, Mt Sinai School of Medicine, New York, NY, USA; Manhattan HIV Brain Bank, Mt. Sinai School of Medicine, One Gustave Levy Place, Box 1134, New York, NY 10029, USA
| | - Desiree Byrd
- Department of Pathology, Mt Sinai School of Medicine, New York, NY, USA; Manhattan HIV Brain Bank, Mt. Sinai School of Medicine, One Gustave Levy Place, Box 1134, New York, NY 10029, USA
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Gyarmathy VA, Neaigus A. The relationship of sexual dyad and personal network characteristics and individual attributes to unprotected sex among young injecting drug users. AIDS Behav 2009; 13:196-206. [PMID: 17690975 PMCID: PMC2651987 DOI: 10.1007/s10461-007-9285-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 07/16/2007] [Indexed: 10/23/2022]
Abstract
We examine in the heterosexual partnerships (dyads) of IDUs the correlates of engaging in unprotected sex on three levels: individual attributes, social network characteristics, and dyad characteristics. Unprotected sex was significantly less likely to occur in dyads where the participant injected daily or had high safe-sex attitude scores, and in dyads where both members encouraged each other to use condoms. Unprotected sex was significantly more likely to occur in dyads that smoked crack together, shared needles with each other, and where the participant knew that the sex partner had concurrent sex partners. In the sexual dyads of IDUs there is a combined risk of unsafe injecting and unsafe sex. Both injecting and sexual risk, and their combination need to be addressed in interventions that target the sexual partnerships of IDUs. Such interventions should also aim to reduce injected and non-injected crack and other stimulant use associated with high-risk sex.
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Affiliation(s)
- V Anna Gyarmathy
- National Development and Research Institutes, Inc., 71 W 23rd St., 8th Floor, New York, NY 10010, USA.
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Abstract
Drug users are an especially complex population among those studied in HIV risk behavior research. Although injection drug use accounts for over one third of the cumulative HIV transmission in the United States, the scope of the direct and indirect impacts of all drug use is difficult to quantify, especially in relation to attributing HIV to drug use directly, via parenteral exposures, or indirectly, through unsafe sex. Important behavioral issues such as social and drug network overlaps, partner selection, and the combinations of illicit drugs with erectile dysfunction medications have added complexity to the study of sexual behavior in drug users. This review covers recent substantive research in the United States and Canada on current themes in sexual risk behavior in injection drug and non-injection drug users. We address gender, situational, and sexual preference factors that may influence sexual behaviors affecting HIV risk by class of drug and route of administration. Special attention is paid to minority populations, both sexual and racial/ethnic, as their marginalized role in contemporary society places special barriers to risk reduction.
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Metsch LR, Pereyra M, Messinger S, Del Rio C, Strathdee SA, Anderson-Mahoney P, Rudy E, Marks G, Gardner L. HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care. Clin Infect Dis 2008; 47:577-84. [PMID: 18624629 DOI: 10.1086/590153] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We examined the relationship between receipt of medical care for human immunodeficiency virus (HIV) infection and HIV transmission risk behavior among persons who had received a recent diagnosis of HIV infection. METHODS We enrolled 316 participants from 4 US cities and prospectively followed up participants for 1 year. Generalized estimating equations were used to examine whether having at least 3 medical care visits in a 6-month period was associated with unprotected vaginal or anal intercourse with an HIV-negative partner or partner with unknown HIV status. RESULTS A total of 27.5% of the participants (84 of 305) self-reported having unprotected sex with an HIV-negative or unknown status partner at enrollment, decreasing to 12% (31 of 258) and 14.2% (36 of 254) at 6-month and 12-month follow-ups, respectively. At follow-up, people who had received medical care for HIV infection at least 3 times had reduced odds of engaging in risk behavior, compared with those with fewer visits. Other factors associated with reduced risk behavior were being >30 years of age, male sex, not having depressive symptoms, and not using crack cocaine. CONCLUSIONS Being in HIV care is associated with a reduced prevalence of sexual risk behavior among persons living with HIV infection. Persons linked to care can benefit from prevention services available in primary care settings.
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Affiliation(s)
- Lisa R Metsch
- Miller School of Medicine, University of Miami, Miami, Florida, USA
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Norton WE, Amico KR, Fisher WA, Copenhaver MM, Kozal MJ, Cornman DH, Friedland G, Fisher JD. Attitudes toward needle-sharing and HIV transmission risk behavior among HIV+ injection drug users in clinical care. AIDS Care 2008; 20:462-9. [PMID: 18449824 DOI: 10.1080/09540120701867081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Risky behavior related to injection drug use accounts for a considerable proportion of incident HIV infection in the United States. Large numbers of injection drug users (IDUs) currently receive antiretroviral therapy in clinical settings and are accessible for risk-reduction interventions to reduce transmission of drug-resistant HIV and spread of HIV to uninfected others. The current study examined attitudes toward needle- or equipment-sharing among 123 HIV-positive IDUs in clinical care in an effort to understand the dynamics of such behavior and to create a basis for clinic-based risk-reduction interventions. Results indicate that at baseline, participants who reported extremely negative attitudes toward needle-sharing were less likely to have shared during the past month than those with less-extreme negative attitudes. Demographic, behavioral, and attitudinal variables were entered into a logistic regression model to examine needle-sharing group membership among HIV-positive IDUs. Being female and having less-extreme negative attitudes toward sharing were independent and significant correlates of sharing behavior. Interventions targeting needle-sharing attitudes deployed within the clinical care setting may be well-positioned to reduce HIV transmission among HIV-positive IDUs.
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Affiliation(s)
- Wynne E Norton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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The impact of mental health and substance abuse factors on HIV prevention and treatment. J Acquir Immune Defic Syndr 2008; 47 Suppl 1:S15-9. [PMID: 18301129 DOI: 10.1097/qai.0b013e3181605b26] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The convergence of HIV, substance abuse (SA), and mental illness (MI) represents a distinctive challenge to health care providers, policy makers, and researchers. Previous research with the mentally ill and substance-abusing populations has demonstrated high rates of psychiatric and general medical comorbidity. Additionally, persons living with HIV/AIDS have dramatically elevated rates of MI and other physical comorbidities. This pattern of co-occurring conditions has been described as a syndemic. Syndemic health problems occur when linked health problems involving 2 or more afflictions interact synergistically and contribute to the excess burden of disease in a population. Evidence for syndemics arises when health-related problems cluster by person, place, or time. This article describes a research agenda for beginning to understand the complex relations among MI, SA, and HIV and outlines a research agenda for the Social and Behavioral Science Research Network in these areas.
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Remien RH, Exner TM, Morin SF, Ehrhardt AA, Johnson MO, Correale J, Marhefka S, Kirshenbaum SB, Weinhardt LS, Rotheram-Borus MJ, Catz SL, Gore-Felton C, Chesney MA, Kelly J. Medication adherence and sexual risk behavior among HIV-infected adults: implications for transmission of resistant virus. AIDS Behav 2007; 11:663-75. [PMID: 17243012 DOI: 10.1007/s10461-006-9201-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 12/05/2006] [Indexed: 11/25/2022]
Abstract
As more people are living long-term with HIV there are growing concerns about specific behaviors that can affect both personal and the public health. This study examined the relationship between antiretroviral therapy (ART) adherence and sexual risk behavior and their association with psychosocial and health factors among a diverse sample of 2,849 HIV-infected adults. Only 8.5% of the sample reported both non-adherence and sexual risk. Individuals were 46% more likely to report one of these risk outcomes when the other one was present and the presence of both outcomes was associated with an increased likelihood of having a detectable viral load. A simultaneous polytomous regression analysis revealed complex relationships among a range of psychosocial variables and the two primary behavioral risk outcomes. There is a need for targeted interventions and integration of mental health and substance use services into primary HIV care settings.
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Affiliation(s)
- Robert H Remien
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
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Berg CJ, Michelson SE, Safren SA. Behavioral aspects of HIV care: adherence, depression, substance use, and HIV-transmission behaviors. Infect Dis Clin North Am 2007; 21:181-200, x. [PMID: 17502235 DOI: 10.1016/j.idc.2007.01.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A variety of psychosocial stressors are involved in living with HIV, maintaining a regimen of highly active antiretroviral therapy, and negotiating necessary self-care behaviors. Because health care providers are in regular contact with HIV-infected individuals in care, these contacts allow for the opportunity to assess and intervene on important variables related to quality of life and HIV outcomes. This article reviews information about four important behavioral aspects of HIV care: treatment adherence, depression, high-risk sex, and substance abuse. Efforts by health care providers to address these factors may result in better treatment outcomes, enhanced quality of life among HIV patients, and decreased HIV transmission.
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Affiliation(s)
- Carla J Berg
- Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
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Abstract
The nature, context and frequency of use of various licit and illicit non-injection drugs associated with an elevated risk of HIV infection. Beyond HIV, a high proportion of HIV-infected IDUs are co-infected with HCV (hepatitis C virus). In this review, we provide a brief review of the epidemiology of these problems, discuss behavioral interventions that can reduce ongoing high risk behaviors among HIV-seropositive IDUs and MSM-DUs, and review the literature which has evaluated their effectiveness. The majority of these interventions have focused on HIV-seronegative heterosexuals and therefore need to be considered in this larger context; however, where possible we discuss the potential impact of these interventions among HIV-seropositive persons. In addition, we briefly discuss interventions which have the potential to simultaneously reduce ongoing transmission of both HIV and HCV. Finally, given the dearth of information on the effectiveness of behavioral interventions in reducing the burden of the HIV and HCV epidemics among persons already infected with either or both viruses, we describe some newer, promising interventions and offer suggestions for future studies.
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Affiliation(s)
- Steffanie A Strathdee
- Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
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Kim TW, Kertesz SG, Horton NJ, Tibbetts N, Samet JH. Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems. BMC Health Serv Res 2006; 6:19. [PMID: 16504167 PMCID: PMC1421395 DOI: 10.1186/1472-6963-6-19] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 02/27/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because individuals with HIV/AIDS often have complex medical and social needs, the impact of housing status on medical service utilization is difficult to isolate from the impact of conditions that may worsen during periods of homelessness such as depression and substance abuse. We examine whether episodes of homelessness are independently associated with suboptimal medical utilization even when accounting for concurrent addiction severity and depression. METHODS We used data from a 30-month cohort of patients with HIV/AIDS and alcohol problems. Housing status, utilization (ambulatory visits, emergency department (ED) visits, and hospitalizations) and other features were assessed with standardized research interviews at 6-month intervals. Multivariable longitudinal regression models calculated incidence rate ratios (IRR) comparing utilization rates during 6-month intervals (homeless versus housed). Additional models assessed whether addiction severity and depressive symptoms could account for utilization differences. RESULTS Of the 349 subjects, 139 (39%) reported homelessness at least once during the study period; among these subjects, the median number of nights homeless per 6-month interview period was 30. Homelessness was associated with higher ED utilization (IRR = 2.17; 95% CI = 1.72-2.74) and hospitalizations (IRR = 2.30; 1.70-3.12), despite no difference in ambulatory care utilization (IRR = 1.09; 0.89-1.33). These associations were attenuated but remained significant when adjusting for addiction severity and depressive symptoms. CONCLUSION In patients with HIV/AIDS and alcohol problems, efforts to improve housing stability may help to mitigate intensive medical utilization patterns.
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Affiliation(s)
- Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Stefan G Kertesz
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham School of Medicine and the Deep South Center on Effectiveness and the Birmingham Veterans' Affairs Medical Center, Birmingham, AL, USA
| | | | | | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA
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Abstract
AIDS has steadily increased in recent years, becoming the ninth leading killer of Native people between the ages of 15 and 44. In 2003, the Centers for Disease Control and Prevention (CDC) reported that ethnic minorities account for more than 71% of all reported AIDS cases and that there are still increases in AIDS cases in the American Indian population. Despite the work that has been done related to HIV/AIDS, there remain some major challenges in the prevention of HIV/AIDS in Native communities. Yet, there are changes on the horizon and these changes bring hope to Native communities in the ongoing battle to decrease HIV and AIDS. This article details information about the biological, social, economic and behavioral cofactors related to the rise in HIV/AIDS in Native communities and follows with issues related to special populations and consideration of the unique needs of prevention in these subpopulations. The need for norming of HIV testing is discussed as is the need for Native-specific programs and interventions. Finally, changes in the recognition of the culturally specific needs of Native people are noted and new resources are presented.
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Affiliation(s)
- Irene Vernon
- Center for Applied Studies in American Ethnicity, Colorado State University, Fort Collins, Colorado 80523, USA
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Abstract
HIV infection among racial and ethnic minorities is an ongoing health crisis. The disproportionate impact of HIV infection on racial and ethnic minorities has affected communities already struggling with many social and economic challenges, such as poverty, substance abuse, homelessness,unequal access to health care, and unequal treatment once in the health care system. Superimposed on these challenges is HIV infection, the transmission of which is facilitated by many of these factors. Although the epidemic is disproportionately affecting all racial and ethnic minorities, within these minority populations women are particularly affected. The care and management of racial and ethnic minorities who have HIV infection has been complicated by the unequal access to health care and the unequal treatment once enrolled in health care. Health insurance status, lack of concordance between the race of the patient and the provider, and satisfaction with the quality of their care all impact on treatment outcomes in this population. In addition, the provider must be aware of the many comorbid conditions that may affect the delivery of care to minority patients living with HIV infection: depression, substance and alcohol abuse, and posttraumatic stress disorders. The impact of these comorbid conditions on the therapeutic relationship, including treatment and adherence, warrants screening for these disorders and treating them when identified. Because the patient provider relationship has been repeatedly identified as a predictor of higher adherence, developing and maintaining a strong therapeutic alliance is critical. Participation of racial and ethnic minorities in HIV clinical trials, as in other disease states, has been very poor. Racial and ethnic minorities have been chronically underrepresented in HIV clinical trials, despite their overrepresentation in the HIV epidemiology. This underrepresentation seems to be the result of a combination of factors including (1) provider bias in referring to clinical trials, (2) mistrust of clinical research, (3) past poor experience with the health care system, and (4) the conspiracy theories of HIV disease. The paucity of minority health care professionals and minority investigators in HIV research further affects minority participation in clinical research. To improve racial and ethnic minority participation in clinical trials a sustained effort is necessary at multiple levels. Increased recruitment and retention is an ongoing need, and one that will not be satisfactorily addressed until there are better community-academic and research partner-ships, and the research questions posed also address issues of concern and significance to the affected community. Reduction in barriers to participation in clinical trials, especially given the many competing needs of racial and ethnic minority patients, is also needed. Multidisciplinary HIV care teams and research staff with training in cultural competency and cultural sensitivity may also be helpful. Prevention of HIV infection remains essential, especially among those seeking care for HIV infection. Despite several published recommendations for the inclusion of HIV prevention in the clinical care setting, studies have documented how few providers actually achieve this goal, especially those who care for disadvantaged patients. Although there are many barriers to discussing HIV risk behaviors and prevention strategies in an office visit,including time constraints and potential provider discomfort in discussing these matters, clinical visits represent an important opportunity to reinforce HIV prevention and possibly decrease further HIV transmission.
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Affiliation(s)
- Victoria A Cargill
- Office of AIDS Research, National Institutes of Health, 2 Center Drive, Room 4E20, Bethesda, MD 20892-0255, USA.
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