Characteristics of Individuals Infected With HIV
Characteristics of Individuals Infected With HIV
Background. This detailed study describes the demographic characteristics, behavioral characteristics, care-seeking behavior, and barriers to health care and social services for patients infected with the human immunodeficiency virus (HIV) in the Southeast.
Methods. We conducted a cross-sectional study of Medicaid-eligible HIV-positive individuals (chart abstractions [N = 679], patient surveys [N = 487]) and care providers (N = 101) in North Carolina. Relative risks compare blacks, women, and respondents reporting substance abuse with their reference groups. Results are compared with those of a larger sample including persons from Alabama and South Carolina.
Results. Forty-one percent of respondents did not receive care locally, and 69% of female respondents had young children at home. In the 12 months before the survey, 66% reported substance abuse; 49% reported multiple living situations; 11% had entered drug treatment; and 10% had difficulty with the law. The findings in North Carolina did not differ from those in Alabama and South Carolina. Mean indices from care provider surveys revealed low interagency knowledge and referrals.
Conclusions. Patients have complex needs for both social services and health care. However, providers are not working together.
Treatment of patients infected with HIV and patient characteristics have changed dramatically over the past 8 years. New theraputic agents have greatly increased the life expectancy of persons with HIV, changing it from a debilitating infectious disease to a chronic, manageable infectious disease to be treated over the course of many years. While mortality from the acquired immunodeficiency syndrome (AIDS) has decreased, the prevalence of persons living with HIV has increased. The possibility of treatment has encouraged some individuals to be tested earlier, but new therapeutic regimens for HIV are complex both to adhere to and to prescribe. Decreases in adherence have been correlated with increases in the number of pills in a regimen. Some HIV treatments require taking 15 pills or more per day for an indefinite period. Being able to adhere to difficult regimens is associated with being able to live in a way that facilitates focusing consistently on self-care.
National trend data have identified emerging HIV-positive populations. The new wave of HIV infection in the United States targets individuals who are predominantly heterosexual, nonwhite, female, young, poor, and as likely to be rural-living as urban-living. Blacks and women continue to represent an increasing proportion of persons reported with AIDS. In 1996, blacks represented 41% and women represented 20% of adults reported with AIDS. Also, women comprise a higher percentage of HIV-positive individuals in rural settings as compared with urban areas. Behavioral characteristics of those who are becoming infected with HIV have also changed. Nationally, the proportion of cases attributed to heterosexual transmission increased from 3% to 14.5%. The proportion of AIDS cases among persons who reported injection drug use increased from 17% in the initial phase of the epidemic (1981 to 1987) to 26% in 1998.
The southeastern United States has consistently reported the largest number of AIDS cases since 1988. From 1989 to 1993, the South had higher proportionate rates of increase in AIDS cases relative to the rest of the United States. With the successes of combination therapy by 1994, AIDS incidence in the United States began to decrease, but it decreased less in the South than in the remainder of the United States (except in 1997 and 1999). The Centers for Disease Control and Prevention's (CDC) definition of the South includes Florida, Texas, and Virginia. When we look at statistics for states that are demographically similar in the proportion of the population that is rural (fewer than 200 persons per square mile) and black and poor (Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina), we find that in each of these states patients infected with HIV or AIDS are at least 70% black and 25% female. Additionally, we find consistently fewer decreases in AIDS incidence than those states included in the CDC definition of the South and in the nation. Although provocative, national trend data are too superficial to be useful in informing providers how patient groups differ in their interaction with care systems. Only with an indepth understanding of patient characteristics and provider systems can barriers to care be identified and reduced. Also, populations affected by the new epidemic represent traditionally disenfranchised groups who do not engage in the health care system in the way that others do. Specifically, blacks and rural-living individuals have higher rates of chronic diseases and age-specific mortality, are provided less aggressive care, and are more costly to the care system.
Furthermore, research has shown that integrated care delivery systems have proven beneficial to patients' health and financial resources. Integrated services can reduce hospital stays, increase retention in treatment programs, facilitate return to work, reduce cost, and increase patient and provider satisfaction. To provide adequate care to patients with multiple needs and comorbidity, effective coordination of care can support providers, particularly those in rural areas, by reducing feelings of isolation and work burden. Such coordination educates providers in accessing other providers inside and outside of their organization.
A more detailed understanding of the new wave of HIV-positive individuals will increase the understanding and enhance the decision-making process of providers, policy-makers, and administrators. This study furthers our understanding characteristics of HIV-infected patients in the Southeast by examining differences between men and women, blacks and nonblacks, and substance abusers and non-substance abusers in demographics, behavioral characteristics, health status, care-seeking behavior, and reported barriers to care. The study also examines the provider network through an evaluation of the level of knowledge, interrelated patient referral activity and satisfaction that care providers have with other providers of HIV-related services in their catchment area. Three unique datasets are examined: 679 medical record abstractions for Medicaid-eligible HIV-positive persons linked with a subsample of 487 patient survey respondents and 101 providers of HIV-related medical and social services in North Carolina. The patient medical chart abstraction and survey results are briefly compared with results for the larger sample, which includes Alabama and South Carolina. This study is the first HIV survey study of this magnitude and depth in the predominantly rural Southeast.
Background. This detailed study describes the demographic characteristics, behavioral characteristics, care-seeking behavior, and barriers to health care and social services for patients infected with the human immunodeficiency virus (HIV) in the Southeast.
Methods. We conducted a cross-sectional study of Medicaid-eligible HIV-positive individuals (chart abstractions [N = 679], patient surveys [N = 487]) and care providers (N = 101) in North Carolina. Relative risks compare blacks, women, and respondents reporting substance abuse with their reference groups. Results are compared with those of a larger sample including persons from Alabama and South Carolina.
Results. Forty-one percent of respondents did not receive care locally, and 69% of female respondents had young children at home. In the 12 months before the survey, 66% reported substance abuse; 49% reported multiple living situations; 11% had entered drug treatment; and 10% had difficulty with the law. The findings in North Carolina did not differ from those in Alabama and South Carolina. Mean indices from care provider surveys revealed low interagency knowledge and referrals.
Conclusions. Patients have complex needs for both social services and health care. However, providers are not working together.
Treatment of patients infected with HIV and patient characteristics have changed dramatically over the past 8 years. New theraputic agents have greatly increased the life expectancy of persons with HIV, changing it from a debilitating infectious disease to a chronic, manageable infectious disease to be treated over the course of many years. While mortality from the acquired immunodeficiency syndrome (AIDS) has decreased, the prevalence of persons living with HIV has increased. The possibility of treatment has encouraged some individuals to be tested earlier, but new therapeutic regimens for HIV are complex both to adhere to and to prescribe. Decreases in adherence have been correlated with increases in the number of pills in a regimen. Some HIV treatments require taking 15 pills or more per day for an indefinite period. Being able to adhere to difficult regimens is associated with being able to live in a way that facilitates focusing consistently on self-care.
National trend data have identified emerging HIV-positive populations. The new wave of HIV infection in the United States targets individuals who are predominantly heterosexual, nonwhite, female, young, poor, and as likely to be rural-living as urban-living. Blacks and women continue to represent an increasing proportion of persons reported with AIDS. In 1996, blacks represented 41% and women represented 20% of adults reported with AIDS. Also, women comprise a higher percentage of HIV-positive individuals in rural settings as compared with urban areas. Behavioral characteristics of those who are becoming infected with HIV have also changed. Nationally, the proportion of cases attributed to heterosexual transmission increased from 3% to 14.5%. The proportion of AIDS cases among persons who reported injection drug use increased from 17% in the initial phase of the epidemic (1981 to 1987) to 26% in 1998.
The southeastern United States has consistently reported the largest number of AIDS cases since 1988. From 1989 to 1993, the South had higher proportionate rates of increase in AIDS cases relative to the rest of the United States. With the successes of combination therapy by 1994, AIDS incidence in the United States began to decrease, but it decreased less in the South than in the remainder of the United States (except in 1997 and 1999). The Centers for Disease Control and Prevention's (CDC) definition of the South includes Florida, Texas, and Virginia. When we look at statistics for states that are demographically similar in the proportion of the population that is rural (fewer than 200 persons per square mile) and black and poor (Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina), we find that in each of these states patients infected with HIV or AIDS are at least 70% black and 25% female. Additionally, we find consistently fewer decreases in AIDS incidence than those states included in the CDC definition of the South and in the nation. Although provocative, national trend data are too superficial to be useful in informing providers how patient groups differ in their interaction with care systems. Only with an indepth understanding of patient characteristics and provider systems can barriers to care be identified and reduced. Also, populations affected by the new epidemic represent traditionally disenfranchised groups who do not engage in the health care system in the way that others do. Specifically, blacks and rural-living individuals have higher rates of chronic diseases and age-specific mortality, are provided less aggressive care, and are more costly to the care system.
Furthermore, research has shown that integrated care delivery systems have proven beneficial to patients' health and financial resources. Integrated services can reduce hospital stays, increase retention in treatment programs, facilitate return to work, reduce cost, and increase patient and provider satisfaction. To provide adequate care to patients with multiple needs and comorbidity, effective coordination of care can support providers, particularly those in rural areas, by reducing feelings of isolation and work burden. Such coordination educates providers in accessing other providers inside and outside of their organization.
A more detailed understanding of the new wave of HIV-positive individuals will increase the understanding and enhance the decision-making process of providers, policy-makers, and administrators. This study furthers our understanding characteristics of HIV-infected patients in the Southeast by examining differences between men and women, blacks and nonblacks, and substance abusers and non-substance abusers in demographics, behavioral characteristics, health status, care-seeking behavior, and reported barriers to care. The study also examines the provider network through an evaluation of the level of knowledge, interrelated patient referral activity and satisfaction that care providers have with other providers of HIV-related services in their catchment area. Three unique datasets are examined: 679 medical record abstractions for Medicaid-eligible HIV-positive persons linked with a subsample of 487 patient survey respondents and 101 providers of HIV-related medical and social services in North Carolina. The patient medical chart abstraction and survey results are briefly compared with results for the larger sample, which includes Alabama and South Carolina. This study is the first HIV survey study of this magnitude and depth in the predominantly rural Southeast.