Clients without health insurance at publicly funded HIV counseling and testing sites: implications for early intervention.

The characteristics of clients reporting no health insurance were compared with those reporting any health insurance at publicly funded human immunodeficiency virus (HIV) counseling and testing sites in the United States during 1992. Thirty of 65 funded health departments collect data on self-reported health insurance status. Data were dichotomized into two groups, clients reporting any health insurance versus those reporting none, and multivariate logistic models were developed to explore independent associations. Of the 885,046 clients studied, 440,416 reported that they lacked health insurance. Clients without health insurance were more likely to be male, members of racial or ethnic minorities, adolescent, and HIV seropositive. Prisoners (odds ratio = 0.26), clients of Hispanic ethnicity (odds ratio = 0.52), and clients receiving testing during field visits (odds ratio = 0.53) in drug treatment centers (odds ratio = 0.55) and in tuberculosis clinics (odds ratio = 0.55) were less likely to have health insurance. Injecting drug users, whether heterosexual (odds ratio = 0.65) or homosexual (odds ratio = 0.67), were less likely to have health insurance compared with other behavioral risk groups. Large numbers of clients receiving publicly funded HIV counseling and testing lack health insurance. Lack of health insurance may interfere with subsequent receipt of needed primary care services among high-risk clients, especially HIV seropositive clients in need of early intervention services.     

HIV seroprevalence surveys in sexually transmitted disease clinics

The Centers for Disease Control, in cooperation with State and local health departments, is conducting human immunodeficiency virus, type 1 (HIV), seroprevalence surveys, using standard protocols, in sexually transmitted disease (STD) clinics in selected metropolitan areas throughout the United States. The surveys are blinded (serologic test results not identified with a person) as well as nonblinded (clients voluntarily agreeing to participate). STD clinics are important sentinel sites for the surveillance of HIV infection because they serve persons who are at increased risk as a result of certain behaviors, such as unprotected sex, homosexual exposure, or intravenous drug use. HIV seroprevalence rates will be obtained in the sentinel clinics each year so that trends in infection can be assessed over an extended period of time. Behaviors that place clients at risk for infection, or protect against infection, are being evaluated in voluntary, nonblinded surveys to define groups for appropriate interventions and to detect changes in response to education and prevention programs. Although inferences drawn from the surveys are limited by the scope of the clinics and clients surveyed, HIV trends in STD clinic client populations should provide a sensitive monitor of the course of the acquired immunodeficiency syndrome (AIDS) epidemic among persons engaging in high-risk sexual behaviors.     

德宏傣族景颇族自治州不同年龄跨境婚姻人群艾滋病相关公共卫生服务现况

目的  了解德宏自治州跨境婚姻人群艾滋病相关公共卫生服务现况及其年龄差异。 方法  采用横断面调查研究,2017年5月-2019年6月,招募德宏州所有跨境婚姻人员开展调查。 结果  共调查并纳入分析32 182人,年龄15~85岁。曾接受过艾滋病检测服务、近1年接受过艾滋病相关干预服务、近1年得到关怀帮助和参加新农合比例分别为57.8%、92.7%、6.5%和94.5%;其中后三项存在年龄差异（P < 0.001）。多因素Logistic回归分析显示,曾接受过艾滋病检测服务的影响因素包括年龄（51~85岁：OR=0.71,95% CI：0.63~0.81）、女性（OR=1.14,95% CI：1.03~1.25）、地区（陇川：OR=6.30,95% CI：5.72~6.93;梁河：OR=1.27,95% CI：1.11~1.44;盈江：OR=0.88,95% CI：0.82~0.94）、傣族（OR=1.60,95% CI：1.50~1.72）、婚姻登记（办理边民通婚登记：OR=0.60,95% CI：0.56~0.65;未办任何手续：OR=0.66,95% CI：0.62~0.70）、结婚年数（4~5年：OR=1.21,95% CI：1.12~1.31;6~60年：OR=1.30,95% CI：1.22~1.39）、近1年未得到关怀帮助（OR=0.64,95% CI：0.58~0.71）、未参加新农合（OR=0.58,95% CI：0.52~0.65）。 结论  德宏州跨境婚姻人群艾滋病相关公共卫生服务总体实施较好。但是,接受艾滋病检测服务比例相对较低,需在个别人群和县市加强检测。     

成都市男男性行为人群HIV感染者卫生服务利用现况调查

目的了解成都市男男性行为人群(MSM)艾滋病病毒(HIV)感染者对随访咨询、CD4检测、性伴告知和检测等艾滋病相关卫生服务利用现况,为制定干预措施提供可用信息。方法研究对象招募采用滚雪球方法,调查问卷采用面对面方式,对社会人口学特征、艾滋病预防干预和相关医疗服务利用情况等信息进行统计描述。采用SAS9.13统计软件进行统计学处理。结果共调查MSM人群HIV感染者202人,其中约30%的人未接受过安全套、润滑剂发放和同伴教育等预防干预服务;35.2%的人在出现性病症状后未到正规医疗机构的规范诊疗服务;11.4%的人未检测过CD4;41.4%的人未将自己的感染状态告知他人,包括性伴;76.9%的人从未介绍过自己的性伴去检测HIV。结论预防干预、性病诊疗、CD4检测以及促进性伴告知和检测等艾滋病性病相关医疗服务在MSM人群HIV感染者中的利用率均较低,需制定针对性干预措施,提高相关服务覆盖面和服务质量。     

More than just talk: the framing of transactional sex and its implications for vulnerability to HIV in Lesotho, Madagascar and South Africa

Background

Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs).

Methods

Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors.

Results

Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included: criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers.

Conclusions

Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater accessibility because of multiple, complex, and interrelated barriers to HIV/AIDS service utilisation at the service delivery level. Factors external to, as well as within, the health sector are key to understanding the access deficit in the FSU where low or concentrated HIV/AIDS epidemics are prevalent. Funders of HIV/AIDS programmes need to consider how best to tackle key structural and systemic drivers of access including prohibitionist legislation on drugs use, limited transparency and low staff salaries within the health sector.     

Housing needs of persons with HIV and AIDS in New York State

OBJECTIVE: To understand the scope and magnitude of housing needs among persons with HIV/AIDS in New York State. DESIGN: Both housing providers and non-housing providers were identified through state-wide lists and regional resource guides. All identified housing providers and a random sample of identified non-housing providers, by region, were approached. Interviewers conducted telephone interviews with qualified representatives from each organization. RESPONDENTS: All major providers of HIV/AIDS housing services (n = 144) and a random sample of other providers of HIV/AIDS services (n = 87) were interviewed. VARIABLES UNDER STUDY: Data that were gathered included: agency profiles, client demographics, and clients' need for and use of housing services. RESULTS: One-third of housing agency clients were either homeless or living in a welfare hotel, while one-tenth of non-housing agency clients lived under such conditions. Nearly one-third of all clients were living doubled-up, and half had problems paying for rent or utilities. The majority of clients required supportive services such as substance abuse treatment or mental health care. CONCLUSIONS: With the advent of protease inhibitor therapy, stable and adequate housing has become especially critical for persons with HIV/AIDS. However, public assistance "reforms" are likely to exacerbate their housing needs, and may ultimately compromise the potential benefits of treatment.     

Determining HIV seroprevalence among women in women's health clinics

Human immunodeficiency virus, type 1 (HIV), seroprevalence studies are needed to determine the level and trends of HIV infection among women attending family planning, abortion, and prenatal care clinics in the United States. A review of published and unpublished studies showed that HIV seroprevalence among women attending women's health clinics was 0 to 2.6 percent, although the studies were difficult to compare because of differences in methodology. The Centers for Disease Control, in association with State and local health departments, has developed a standardized protocol to determine HIV seroprevalence among women attending women's health clinics in selected metropolitan areas. Blinded HIV serosurveys (serologic test results not identified with a person) are being conducted annually in selected sentinel clinics in order to obtain estimates of HIV seroprevalence unbiased by self-selection, as well as to monitor trends in infection among clients attending these clinics. In areas with high HIV seroprevalence, nonblinded serosurveys (in which clients voluntarily agree to participate) will be used to assess behaviors that may place women at increased risk of exposure to HIV. Data from the surveys can be used in developing age-specific and culturally appropriate AIDS educational materials, assessing the amount and type of counseling activities required, and evaluating acquired immunodeficiency syndrome (AIDS) prevention activities. The information will provide epidemiologic data to complement the results of other surveys in characterizing the scope of HIV infection among women of childbearing age in the United States.     

Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda

BACKGROUND: To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda. METHODS: Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach. RESULTS: The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families. CONCLUSION: Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the 'opt-out' approach to HIV testing required further evaluation.     

The Quality of HIV Testing Services for Adolescents in Cape Town,South Africa: Do Adolescent-Friendly Services Make a Difference?

We used adolescent simulated clients to evaluate whether HIV testing services in clinics participating in an adolescent-friendly initiative in Cape Town were superior to regular clinic services. We found improved accessibility to HIV testing, but no impact on adolescent’s experience of negative attitudes from health workers and confidentiality breaches.     

HIV seroprevalence surveys in drug treatment centers

Sharing of equipment used to inject illicit drugs intravenously is a risk factor for human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Systematic surveillance of HIV infection among intravenous drug users (IVDUs) in the United States is essential to monitor the HIV epidemic and to target and evaluate prevention programs for IVDUs and their partners. The most accessible segment of the largely covert population of IVDUs are those in drug treatment programs. In collaboration with State and local health departments and drug abuse treatment agencies, the Centers for Disease Control is conducting blinded (serologic test results not linked to identifiable persons) and nonblinded (in which clients voluntarily agree to participate) surveys of IVDUs entering drug treatment in 39 U.S. metropolitan areas. The same protocol is used in all participating drug treatment centers. Blinded surveys will be carried out annually to determine HIV seroprevalence rates in eligible IVDUs entering drug treatment and to monitor trends over time. Each year, nonblinded surveys of IVDUs entering drug treatment will assess self-reported drug use and sexual behaviors to help design educational interventions and to detect changes in behavior over time. This sentinel surveillance system, using a standardized methodology, will provide the best national and regional data available on the seroprevalence of HIV among IVDUs and the relationships of drug use, sexual behaviors, and HIV serologic status of IVDUs.     

上海市HIV感染者和艾滋病患者医疗服务可及性研究

[目的]了解上海市艾滋病病毒感染者和艾滋病患者（people livingwith HIV／AIDS,PHA）获得医疗服务的可及性及其影响因素,为进一步的干预研究提供针对性的建议。[方法]采用个人深入访谈和小组访谈的方式,调查50名PHA以及46名包括政策决策者、服务提供者等在内的相关人员,定性调查资料采用N。Vivo8．0进行编码和分析。[结果]上海市PHA医疗服务可及性不足,主要表现在距离可及性远,各区距上海市公共卫生临床中心平均距离达69．0kin,平均车程62min;目前仅一家定点服务机构,服务能力有限、免费抗病毒药物少、流动人口抗病毒治疗服务可及性差;PHA支付艾滋病相关诊疗服务能力不够。[结论]上海市PHA获得医疗服务的可及性很不乐观,而且获得医疗服务的负担重,亟需扩大和合理利用医疗资源,提高艾滋病相关医疗服务的可及性,增强临床关怀。     

Frequency of visits to health facilities and HIV services offered to men,Malawi

ObjectiveTo determine how often men in Malawi attend health facilities and if testing for human immunodeficiency virus (HIV) is offered during facility visits.MethodsWe conducted a cross-sectional, community-representative survey of men (15–64 years) from 36 villages in Malawi. We excluded men who ever tested HIV-positive. Primary outcomes were: health facility visits in the past 12 months (for their own health (client visit) or to support the health services of others (guardian visit)); being offered HIV testing during facility visits; and being tested that same day. We disaggregated all results by HIV testing history: tested ≤ 12 months ago, or in need of testing (never tested or tested > 12 months before).FindingsWe included 1116 men in the analysis. Mean age was 34 years (standard deviation: 13.2) and 55% (617/1116) of men needed HIV testing. Regarding facility visits, 82% (920/1116) of all men and 70% (429/617) of men in need of testing made at least one facility visit in the past 12 months. Men made a total of 1973 visits (mean two visits): 39% (765/1973) were as guardians and 84% (1657/1973) were to outpatient departments. Among men needing HIV testing, only 7% (30/429) were offered testing during any visit. The most common reason for not testing was not being offered services (37%; 179/487).ConclusionMen in Malawi attend health facilities regularly, but few of those in need of HIV testing are offered testing services. Health screening services should capitalize on men’s routine visits to outpatient departments as clients and guardians.     

Rural physical health care services for people with serious mental illness: A nursing perspective

Objective: To understand nurse perspectives on the physical health needs of their mental health clients and how well rural services are meeting their overall care needs. Design: Focus groups with semistructured format. Setting: Community mental health care in a regional and rural district of Queensland. Participants: Thirty‐eight nurses in public mental health care. Results: The major themes were (i) stigma of mental illness, (ii) barriers to accessing physical health care services, (iii) nurse adaptations under demands, and (iv) community and integration towards better overall health. Nurses integrate overall care and foster its continuity for people with physical and mental co‐morbidity and can be supported much better in sustaining this. Conclusion: Access and continuity of physical health care experienced by all Australians is exacerbated for people in rural areas. Physical health of people with serious mental illness residing in remote Australia needs to be a national health priority.     

基于Andersen模型探讨自评HIV感染风险高的学生接受检测服务的影响因素

目的 研究自评HIV感染风险高的青年学生接受HIV检测服务的影响因素。方法 基于Andersen卫生服务利用行为模型及相关文献设计学生HIV检测服务利用行为影响因素的研究框架。采用阶段模型分步骤对2019年3-4月使用青年学生性健康和HIV感染风险评估干预工具（"熊探"）自评HIV感染风险高的学生进行多因素分析。结果 共526名研究对象，年龄（19.30±1.19）岁，其中96.2%（506/526）知道发生高危行为后应主动寻求HIV检测；发生过插入式性行为比例为56.7%（298/526），HIV检测率为11.0%（58/526）；发生过和未发生过插入式性行为的学生HIV检测率分别为13.42%（40/298）和7.89%（18/228）。多因素logistic回归分析结果显示，倾向性特征模块中的性取向为其他（与异性恋相比，OR=7.88，95%CI：3.98~15.61）、艾滋病知识知晓程度较高（与知晓程度较低的相比，OR=2.05，95%CI：1.07~3.93），需要因素模块中的有危险性行为（与未发生过危险性行为的相比，OR=2.66，95%CI：1.41~5.03）、在医院确诊感染过STD （与未感染者相比，OR=6.35，95%CI：2.21~18.27），能力因素模块中的最近1年接受过艾滋病预防知识的宣传（与未接受的相比，OR=0.29，95%CI：0.11~0.76）、最近1年接受过艾滋病自愿咨询检测服务的宣传（与未接受的相比，OR=3.67，95%CI：1.71~7.90）是HIV检测行为的影响因素。结论 学生的检测行动力亟待提高，其知识得分和性取向等倾向因素，以及是否有高危性行为和感染过STD等需要因素对HIV检测服务的利用均有较大的影响。但相比之下，接受过艾滋病预防和咨询检测服务相关知识政策教育等能力因素显得更重要，提示今后要进一步加强自愿咨询检测服务知识政策的教育，尤其是重点关注女生、有危险性行为者的教育。     

Homosexuality and HIV/AIDS stigma in Jamaica

This paper reports on a study of the relationship of homophobia to HIV/AIDS‐related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS‐related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)—to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti‐stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals.     

Evolution of HIV/AIDS prevention programs--United States, 1981-2006

When the first cases of what would become known as acquired immunodeficiency syndrome (AIDS) were reported in 1981, the magnitude of the epidemic and the numbers of deaths were unimaginable. During the next 25 years, an unprecedented mobilization of individual, community, and government resources was directed at stopping the epidemic. CDC currently supports a wide range of human immunodeficiency virus (HIV) prevention activities in the United States, including 1) collection of behavioral and HIV/AIDS case surveillance data that document trends in the epidemic and risk behaviors; 2) programs conducted by state, territorial, and local health departments, community-based and national organizations, and education agencies; 3) capacity building to improve HIV-prevention programs; 4) program evaluation to monitor the delivery and outcomes of prevention services; and 5) research leading to new strategies for preventing transmission of HIV/AIDS. Since 1994, local and state health departments have allocated resources to specific programs and populations through local community planning processes that involve health department staff, prevention providers, and members of affected communities. A three-pronged approach has been developed, consisting of 1) prevention activities directed at persons at high risk for contracting HIV; 2) HIV counseling, testing, and referral services; and 3) prevention activities directed at improving the health of persons living with HIV and preventing further transmission.     

Ryan White CARE Act service use by Asian/Pacific Islanders and other clients in three California metropolitan areas (1997-1998)

The HIV epidemic disproportionately affects historically underserved members of racial/ethnic minorities. This paper compares HIV service use patterns for 653 Asians and Pacific Islanders (APIs) with those of other racial and ethnic minority clients (N = 28,201) at three selected Ryan White Comprehensive AIDS Resource Emergency (CARE) Act grantee sites in California. Study results show a relatively high proportion of APIs with advanced HIV disease. APIs use hospital-based HIV clinics at relatively high rates, and they use HIV case management, housing assistance, day/respite care, food/nutrition, substance abuse treatment, and health education services in relatively low numbers. Research suggests that social, cultural, and economic factors may influence health seeking behaviors and providers' practices. While there are relatively few APIs living with HIV in the US, the rate of API population growth from immigration underscores the need for service providers to take into account cultural and social factors to improve access to treatment.     

Knowledge of Treatment to Reduce Perinatal Human Immunodeficiency Virus (HIV) Transmission and Likelihood of Testing for HIV: Results from Two Surveys of Women of Childbearing Age

Objective: To determine whether knowledge of zidovudine treatment to reduce the risk of mother-to-child transmission of HIV increases the likelihood of HIV testing among women of childbearing age at increased risk for HIV infection. Method: Data from two samples were analyzed. The Young Women Survey was a population-based, door-to-door survey of 2,545 women aged 18 to 29 years who were living in lower-income neighborhoods. For the Perinatal Survey, women receiving prenatal care or who had delivered within the previous six months (N = 850) were recruited at randomly selected sites. Most (71.2%) of these participants were covered by public payment sources for their prenatal care. Data were collected within California counties with high rates of HIV among newborns, high rates of HIV among female clients of alternative test sites, and high rates of AIDS among female injection drug users. Most participants from both surveys were women of color. Results: Participants who knew about zidovudine therapy for HIV-positive pregnant women were more likely to have had an HIV test, regardless of race/ethnicity, age, education, or number of previous births. The majority of women (79.3%) from both samples stated that they were more likely to take a test for HIV knowing about zidovudine treatment. Conclusions: HIV educators should include information on zidovudine therapy in campaigns designed to promote HIV testing among women. Prenatal care providers should incorporate a brief discussion about the benefits of zidovudine treatment when providing HIV counseling to patients.     

Current approaches to prevention of HIV infections.

The HIV education and prevention strategy of the Centers for Disease Control has three principal components: (a) public information and education, (b) education for school-aged populations, and (c) risk reduction education and individual counseling and testing services for people at increased risk of HIV infection. The most visible components of the public information and education programs are the National Public Information Campaign ("America Responds to AIDS"), the National AIDS Hotline system, and the National AIDS Information Clearinghouse. Components of the youth education program consist of funding for national health and education organizations, funding for State and local education departments, training, surveillance of education efforts, and evaluation. Counseling and testing has entailed performance of approximately 2,500,000 HIV antibody tests with pre- and post-test counseling, notification and counseling of sexual and needle-sharing partners of those infected with HIV, and targeted risk reduction education through community-based organizations. Over time, these activities will continue to evolve and become more effective.