Geography Should Not Be Destiny: Focusing HIV/AIDS Implementation Research and Programs on Microepidemics in US Neighborhoods

Nunn, Amy; Yolken, Annajane; Cutler, Blayne; Trooskin, Stacey; Wilson, Phill; Little, Susan J.; Mayer, Kenneth H.

doi:10.2105/ajph.2013.301864

Cited by 67 publications

(67 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Low SES YMSM are more likely to reside in neighborhoods with higher levels of poverty, environments associated with lower access to effective health services, and higher level of untreated sexually transmitted infections (STIs) including HIV, conditions which have been shown to be inextricably connected. 32 As result of such conditions, HIV tends to cluster in neighborhoods, 33 and for Black and Hispanic YMSM, experiences of poverty are contextual factors shown to heighten susceptibility to HIV. 34 In this sample, perceived familial SES was significantly associated with both race/ethnicity and UHF neighborhood/county-level poverty.…”

Section: Discussionmentioning

confidence: 99%

Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM

Halkitis

Kapadia

Ompad

2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

Content HIV infections continue to rise in a new generation of young, gay, bisexual and other men who have sex with men (YMSM) despite three decades of HIV prevention and recent biomedical technologies to deter infection. Objectives To examine the incidence of HIV and the demographics, behavioral, and structural factors associated with incident infections. Design Cohort study. Participants 600 YMSM who were ages 18-19 at baseline. Results At baseline 6 prevalent cases of HIV were detected. Over the course of 36 months and six additional waves of data collection, we identified 43 (7.2%) incident cases of HIV. Incident infections were marginally higher among those residing in neighborhoods with higher rates of HIV prevalence. Using Cox proportional hazards models we detected that hazard ratios for time to HIV seroconversion were significantly higher for Black YMSM (HR = 7.46) and Mixed/Other race YMSM (HR = 7.99), and older age at sexual debut with another man was associated with a lower risk of HIV seroconversion (HR = 0.50), while low perceived familial SES was marginally associated with an increased risk for HIV seroconversion (HR = 2.45). Conclusions These findings support the disparities for HIV that exist within the population of sexual minority men and suggest that we attend to behavioral, structural and social conditions to effectively tailor HIV prevention for a new generation of YMSM with a keen eyes to the conditions faced by racial and ethnic minority YMSM which heightened their risk for acquiring HIV.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM

Halkitis

Kapadia

Ompad

2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

show abstract

“…It is well established that the HIV epidemic in the United States is concentrated geographically in areas that are economically disadvantaged and among those living in poverty. [3,36] In the United States, lower socio-economic status has been described as both a risk factor for and a result of psychiatric disorders. [37] Conditions associated with living in poverty, such as crowding, underemployment, financial and other stress, and exposure to violence may increase the risk of one or more psychiatric disorders.…”

Section: Discussionmentioning

confidence: 99%

“…[1] There are notable geographic differences in the distribution of HIV, with the largest burden of HIV in the Southern United States. [2,3] Complex social forces, including socioeconomic factors and gender, are thought to contribute to growing disparities in HIV incidence in the United States. [4] The HIV epidemic in the United States is considered a concentrated epidemic.…”

Section: Introductionmentioning

confidence: 99%

Poverty matters

Oldenburg

Perez-Brumer

Reisner

2014

Aids

View full text Add to dashboard Cite

“…30,33 , 34 Many HCV infections cluster geographically 35 ; distance from health care resources as well as socioeconomic predictors for access to care may influence HCV screening and care. [36][37][38][39][40] Geographically focused interventions have been effective for addressing geographic disparities in human immunodeficiency virus (HIV) infection, 41,42 and may offer important lessons for community-based HCV programs. Urban communities often have the highest rates of HCV infection, 35 and racial and ethnic minorities have disproportionately higher HCVrelated morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program

et al. 2015

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Many of the five million Americans chronically infected with hepatitis C (HCV) are unaware of their infection and are not in care. OBJECTIVE: We implemented and evaluated HCV screening and linkage-to-care interventions in a community setting. DESIGN: We developed a comprehensive, communitybased HCV screening and linkage-to-care program in a medically underserved neighborhood with high rates of HCV infection in Philadelphia, Pennsylvania. We provided patient navigation services to enroll uninsured patients in insurance programs, facilitate referrals from primary care physicians and link patients to an HCV infectious disease specialist with intention to treat and cure. PATIENTS: Philadelphia residents were recruited through street outreach. MAIN MEASURES: We measured anti-HCV seroprevalence and diagnosis, linkage and retention in care outcomes for chronically infected patients. KEY RESULTS: We screened 1,301 participants for HCV; anti-HCV seroprevalence was 3.9 % and 2.8 % of all patients were chronically infected. Half of chronically infected patients were newly diagnosed; the remaining patients were aware of infection but not in care. We provided confirmatory RNA testing and results, assisted patients with attaining insurance and linked most chronically infected patients to a primary care provider. The biggest barrier to retaining patients in care was obtaining referrals for subspecialty providers; however, we obtained referrals for 64 % of chronically infected participants and have retained most in subspecialty HCV care. Several have commenced treatment. CONCLUSIONS: Non-clinical screening programs with patient navigator services are an effective means to diagnose, link, retain and re-engage patients in HCV care. Eliminating referral requirements for subspecialty care might further enhance retention in care for patients chronically infected with HCV.KEY WORDS: hepatitis C; HCV screening; community-based screening; patient navigation; continuum of care. J Gen Intern Med 30(7):950-7

show abstract

Geography Should Not Be Destiny: Focusing HIV/AIDS Implementation Research and Programs on Microepidemics in US Neighborhoods

Cited by 67 publications

References 11 publications

Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM

Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM

Poverty matters

Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program

Contact Info

Product

Resources

About