Prior evidence suggests that the health and longevity benefits of antiretroviral therapy (ART) for persons living with AIDS (PLWAs) have not been equally distributed across racial/ethnic groups in the United States. Notably, black PLWAs tend to fare worse than their counterparts. We examine the role of neighborhood socioeconomic context on racial/ethnic differences in AIDS treatment and survival in San Francisco. The study population encompassed 4211 San Francisco residents diagnosed with AIDS between 1996 and 2001. Vital status was reported through 2006. Census data were used to define neighborhood-level indicators of income, housing, demographics, employment and education. Cox proportional hazards models were employed in multivariate analyses of survival times. Compared to whites, blacks had a significant 1.4 greater mortality hazard ratio (HR), which decreased after accounting for ART initiation. PLWAs in the lowest socioeconomic neighborhoods had a significant HR of 1.4 relative to those in higher socioeconomic neighborhoods, independent of race/ethnicity. The neighborhood association decreased after accounting for ART initiation. Path analysis was used to explore causal pathways to ART initiation. Racial/ethnic differences in neighborhood residence accounted for 19-22% of the 1.6-1.8 black-white relative odds ratio (ROR) and 14-15% of the 1.3-1.4 Latino-white ROR for delayed or no treatment. Our findings illuminate the independent and synergistic contributions of race and place on treatment disparities and highlight the need for future studies and interventions to address treatment initiation as well as neighborhood effects on treatment differences.

Findings support the hypothesis that the sexual networks of black MSM rather than individual behaviours account for their higher prevalence of HIV compared with non-black MSM. There remains the need specifically to validate different concurrency measures in larger samples and directly assess them as risk factors for acquiring HIV infection.

Couples confronted with HIV infection face significant challenges. Little is known about the impact of HIV on heterosexual couples who account for the vast majority of cases worldwide and an increasing proportion of cases in the USA, especially among women. In this study, analysis of data collected on HIV-discordant couples participating in a ten-week support group revealed four major groups of issues: (1) dealing with the emotional and sexual impact on the relationship; (2) confronting reproductive decisions; (3) planning for the future of children and the surviving partner; and (4) disclosure of the HIV infection to friends and family. These findings have implications for the design of interventions to enhance adaptation to HIV for discordant couples.

Successful development of a vascular prosthesis lined with endothelium may depend on the ability of the attached cells to resist shear forces after implantation. The purpose of this article is to describe a model for measurement of endothelial detachment caused by shear stress and to identify biomaterials that resist loss of attached cells as a result of shear stress. With human umbilical venous endothelium labeled with indium 111-oxine, cellular attachment to uncoated and fibronectin-coated polyester elastomer and expanded polytetrafluoroethylene (e-PTFE) graft surfaces was quantified after an 18-hour incubation. PTFE grafts prepared by immediate seeding were also studied. The relative strength of endothelial attachment was determined by the percentage of the original inoculum remaining after the seeded graft surfaces were subjected to a physiologic shear stress of 15 dynes/cm2 during in vitro perfusion. In polyester elastomer grafts, fibronectin did not significantly increase initial attachment but did increase the percentage of inoculum remaining after perfusion (92.1% vs. 39.74%, p = 0.001). A similar relationship existed between fibronectin-coated e-PTFE and immediately seeded e-PTFE preparations with 61.6% and 25.8%, respectively, of the inoculum remaining after perfusion (p = 0.001). Furthermore, the percentage of inoculum retained on fibronectin-coated polyester elastomer was significantly greater than on fibronectin-coated e-PTFE (p = 0.001). In comparing uncoated grafts, polyester elastomer had 39.7% of the inoculum retained after perfusion whereas only 1.8% was remaining on the e-PTFE grafts (p = 0.0001). We conclude that polyester elastomer permits better endothelial cell attachment than e-PTFE and that fibronectin coating enhances the strength of attachment to both graft materials.