Knowledge, Awareness and Behavior: HIV/AIDS and Disasters

African Americans are the most affected by HIV/AIDS. Both males and females continue to be disproportionately affected by HIV/AIDS. They are often drug users or participate in street/drug subculture. Recent weather disasters have required identification of knowledge, beliefs, conduct norms and behavior patterns that are HIV/AIDS risk factors for disaster survivors. This paper examines patterns of behavior and common practices related to HIV among disaster survivors.

Study background

Data for this paper come from a three year renewal project which focused upon the processes by which illicit drug markets were reformulated after disasters and practices of risk behaviors for HIV/AIDS. Hurricanes Katrina, Gustav and Ike presented the opportunity to examine the impact of disasters upon risky behavior among illicit drug users and sellers.

Methods

From 2010-2013 ethnographic study was conducted in New Orleans, Louisiana, Houston and Galveston, Texas. Staff completed in-depth interviews with 132 focal respondents of drug users and sellers. There were 57 focus groups with 243 focus group participants; 350 drug using/selling respondents completed a survey protocol (CAPI), organized around their experiences during the hurricanes.

Results

In both cities respondents displayed knowledge about HIV, modes of transmission and knew that HIV infection can lead to AIDS. Knowledge about time between exposure and infection was mostly imprecise. Most respondents reported they had been tested for HIV multiple times. A large number of participants reported learning about HIV in school, older respondents (mid-40s to 60) reported their knowledge came from television or the streets. Participants expressed fatalistic attitudes toward HIV, believing the virus was fatal even with medication.

Conclusion

With the increase of disasters, more attention needs to be placed upon programs focused on drug consumers. Schools, clinics, public information sources, i.e., TV and radio can make understanding HIV/AIDS a priority through taking into consideration specific populations and making sure literature and other forms of information is adjusted to their understanding.

Full article at:   http://goo.gl/02sruz

By:  Eloise Dunlap

Eloise Dunlap, Director, National Development and Research Institutes, New York, USA;

^*Corresponding author: Eloise Dunlap, Director, National Development and Research Institutes, Institute for Special Population Research, 71 West 23rd Street, 4th floor, New York, United States, Tel: 6466427358; Fax: 9174380894

J Alcohol Drug Depend. 2016 Feb; 4(1): 230.

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Leveling of Tuberculosis Incidence — United States, 2013–2015

After 2 decades of progress toward tuberculosis (TB) elimination with annual decreases of ≥0.2 cases per 100,000 persons (1), TB incidence in the United States remained approximately 3.0 cases per 100,000 persons during 2013–2015. Preliminary data reported to the National Tuberculosis Surveillance System indicate that TB incidence among foreign-born persons in the United States (15.1 cases per 100,000) has remained approximately 13 times the incidence among U.S.-born persons (1.2 cases per 100,000). Resuming progress toward TB elimination in the United States will require intensification of efforts both in the United States and globally, including increasing U.S. efforts to detect and treat latent TB infection, strengthening systems to interrupt TB transmission in the United States and globally, accelerating reductions in TB globally, particularly in the countries of origin for most U.S. cases...

As they did during the previous 7 years, four states (California, Florida, New York, and Texas) reported >500 cases each in 2015 (Table 1). Together, these four states accounted for 4,839 TB cases, or approximately half (50.6%) of all reported cases. State-specific incidence ranged from 0.5 cases per 100,000 persons (West Virginia) to 9.1 TB cases per 100,000 persons (Alaska) (median state incidence = 2.0). By census division, the highest TB incidence was reported in the Middle Atlantic, West South Central, and Pacific divisions. The largest increases in TB incidence from 2014 to 2015 occurred in the East North Central, New England, Mountain, and West South Central divisions.

Among the 9,563 TB cases reported during 2015, 3,201 (33.5%) occurred among U.S.-born persons, corresponding to an annual TB incidence of 1.2 per 100,000 persons. The 6,335 TB cases among foreign-born persons in the United States (66.2% of the total U.S. cases) corresponded to an annual TB incidence of 15.1 per 100,000 persons (Table 2). Overall national TB incidence remained approximately 3.0 cases per 100,000 persons during 2013–2015 (Figure).

In 2015, most U.S.-born persons reported with TB were either non-Hispanic blacks (1,144 cases) or non-Hispanic whites (991 cases) (Table 2). Among U.S.-born non-Hispanic blacks, TB incidence was at an all-time low (3.3 cases per 100,000 persons). Incidence among U.S.-born non-Hispanic whites remained the lowest (0.5 cases per 100,000). Although U.S.-born Hispanics had the third highest case count (661 cases), they had the second lowest incidence (1.8 cases per 100,000). U.S.-born Native Hawaiians/other Pacific Islanders had the highest incidence (12.7 cases per 100,000), followed by U.S.-born American Indians/Alaska Natives (6.8 cases per 100,000). A total of 344 TB cases occurred among U.S.-born persons aged <15 years (0.6 cases per 100,000), representing 10.7% of all U.S.-born persons reported as having incident TB in 2015.

In 2015, among foreign-born persons with reported TB in the United States, Asians had both the highest case count (3,007 cases) and highest incidence (28.2 cases per 100,000 persons). The top five countries of origin for foreign-born persons with TB were Mexico (n = 1,250; 19.7%), the Philippines (n = 819; 12.9%), India (n = 578; 9.1%), Vietnam (n = 513; 8.1%), and China (n = 424; 6.7%). Together, these countries represent 45.2% of the foreign-born population in the United States (4), but accounted for 56.6% (3,584 cases) of all TB cases among foreign-born persons. Although Mexico-born persons accounted for the largest proportion of foreign-born persons reported with TB, their TB incidence in the United States (10.4 cases per 100,000) was lower than that among persons born in China (24.9 cases per 100,000), India (23.9 cases per 100,000), the Philippines (46.9 cases per 100,000), and Vietnam (47.8 cases per 100,000). From 2014 to 2015, the number of TB cases among Philippines-born persons grew from 755 to 819 (8.5% increase), and the number of TB cases among India-born persons grew from 479 to 578 (20.7% increase). The Philippines-born population in the United States grew from 1,639,286 to 1,747,287 (population growth of 6.6%), and the India-born population grew from 2,166,930 to 2,421,795 (population growth of 11.8%) (4). Ninety-six TB cases occurred among foreign-born persons aged <15 years (6.0 cases per 100,000), representing 1.5% of all foreign-born persons reported as having incident TB in the United States in 2015.

Below:  Tuberculosis (TB) incidence overall and among U.S.- and foreign-born persons, by year — United States, 2000–2015

Full article at:   http://goo.gl/yA6tZc

By:  Jorge L. Salinas, MD^1,2; Godwin Mindra, MBChB^1,2; Maryam B. Haddad, MSN²; Robert Pratt²; Sandy F. Price²; Adam J. Langer, DVM²

¹Epidemic Intelligence Service, CDC; ²Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

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Retaining HIV Patients in Care: The Role of Initial Patient Care Experiences

Cross-sectional studies have shown an association between better patient experiences and health outcomes. However, the direction of causality remains unclear. Our prospective study seeks to determine whether better initial patient experiences predict subsequent retention in HIV care. 

We enrolled patients new to an HIV clinic in Houston, Texas, from August 26, 2013 to November 18, 2013. The patients' overall experience with the HIV provider was based on six items; overall experience with the HIV clinic was based on five items. We measured subsequent retention over the first 6 months and entire first year of HIV care. Analyses included 140 patients. 

Sixty-one percent were non-Hispanic black, 41 % were diagnosed with HIV within the last 3 months, and 36 % had a CD4 cell count <200. Thirty three percent were totally satisfied with their initial HIV provider experience and 32 % were totally satisfied with their initial HIV clinic experience. Retention was 68 % over the first 6 months and 51 % over the first year. 

Satisfaction with the HIV provider at the initial visit significantly predicted 6-month retention in care (aOR = 3.56, p = 0.006). Similar results were found for satisfaction with the HIV clinic (aOR = 4.67, p = 0.002). Neither of the patient experience measures at the initial visit predicted 12-month retention. Patients with better initial care experiences have significantly greater retention in HIV care. The effect of better initial care experiences was limited in duration. 

Consistently improving patient care experiences, not only at baseline and but also on subsequent visits, may be a way to increase retention in HIV care.

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By:  Dang BN1,2,3,4, Westbrook RA5, Hartman CM6,7, Giordano TP6,7,8,9.

• 1VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA. bndang@bcm.edu.
• 2Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX, 77030, USA. bndang@bcm.edu.
• 3Department of Medicine, Baylor College of Medicine, Houston, TX, USA. bndang@bcm.edu.
• 4Harris Health System, Houston, TX, USA. bndang@bcm.edu.
• 5Jesse H. Jones Graduate School of Business, Rice University, Houston, TX, USA.
• 6VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA.
• 7Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.
• 8Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
• 9Harris Health System, Houston, TX, USA. 
• AIDS Behav. 2016 Feb 24

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Trajectories of Aging Long-Term Mexican American Heroin Injectors: The "Maturing Out" Paradox

OBJECTIVE:

To examine the applicability of the "maturing out" theory to a sample of aging Mexican American men who are long-term heroin injectors.

METHOD:

Ethnographic data were collected as part of a cross-sectional study of aging Mexican American heroin users in Houston with 20 current heroin users.

RESULTS:

Findings indicate that dysfunctions that emerge in the heroin lifestyle lead not to cessation but rather to "maturing in," a specific process of social readjustment that returns the heroin user to a stable maintenance pattern of use instead of a recovery phase. This process of paradoxical maturing out can be attributed to the unconditional social support provided to the heroin user by family, peers, and the tecato subculture embedded in Mexican American communities.

DISCUSSION:

Results highlight the implications for the intersection of heroin-related conditions, natural age-related impairments, and cognitive functioning that make this population increasingly susceptible to adverse health consequences.

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By:  Cepeda A1, Nowotny KM2, Valdez A3.

• 1University of Southern California, Los Angeles, USA alicecep@usc.edu (https://sowkweb.usc.edu/faculty/alice-cepeda)
• 2University of Colorado Boulder, USA.
• 3University of Southern California, Los Angeles, USA.
• J Aging Health. 2016 Feb;28(1):19-39. doi: 10.1177/0898264315585503. Epub 2015 May 7. 

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Substance Use and Treatment Seeking in Colonias and Urban Areas of the Texas-Mexico Border - Slides

Slides from:  http://goo.gl/8Qmguq

Via:  https://goo.gl/XcRHTN

A Qualitative Exploration of Perceived Gender Differences in Methamphetamine Use among Women Who Use Methamphetamine on the Mexico-U.S. Border

The purpose of this study is to extend the research on contextual factors that influence the initiation and continued use of methamphetamine (meth) by women on the U.S.-Mexico border. 

At present, a minimal body of literature exists that explores meth use on the Mexico-U.S. border. A purposeful sample of 20 women who were active meth users aged ≥18 years was recruited by trained outreach workers from a variety of meth-user networks in Ciudad Juárez, Mexico, the city bordering El Paso, Texas. 

Respondents participated in in-depth, semi-structured interviews including questions on users' perceived familial, social, and environmental influences of meth use. Gender-based themes emerged from the analysis: 

1. patterns of meth use; 
2. places where drugs were used; 
3. effects of relationship networks on meth use; 
4. differential access to drugs; 
5. trading sex for drugs; 
6. perceived class differences; and 
7. long-term drug use and its consequences. 

Respondents reported a preference for using meth as powder or pills as opposed to smoking or injecting the drug. They reported being introduced to meth by men they trust and relying on men for drug acquisition in spaces less accessible and more dangerous to women. 

They described how the drug changed their lifestyle and their behavior towards family members and friends, including instances of physical and psychological violence. Interventions for women on the Mexico-U.S. border should be developed based on users' social networks to target social processes to prevent initiation and to bring active meth users into treatment.

Purchase full article at:   http://goo.gl/0ZvM9Y

By:   Loza O¹, Ramos R², Ferreira-Pinto J¹, Hernandez MT³, Villalobos SA⁴.

¹a College of Health Sciences , University of Texas at El Paso (http://chs.utep.edu/) , El Paso , TX.

²b Alliance of Border Collaboratives (ABC) , El Paso , TX.

³c School of Public Health , University of California , Berkeley , CA.

⁴d Department of Emergency Medicine , Texas Tech Health Sciences of El Paso, Paul Foster School of Medicine , El Paso , TX.

J Ethn Subst Abuse. 2015 Dec 21:1-20. [Epub ahead of print]

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A Qualitative Exploration of Perceived Gender Differences in Methamphetamine Use among Women Who Use Methamphetamine on the Mexico–U.S. border

The purpose of this study is to extend the research on contextual factors that influence the initiation and continued use of methamphetamine (meth) by women on the U.S.-Mexico border. 

At present, a minimal body of literature exists that explores meth use on the Mexico-U.S. border. A purposeful sample of 20 women who were active meth users aged ≥18 years was recruited by trained outreach workers from a variety of meth-user networks in Ciudad Juárez, Mexico, the city bordering El Paso, Texas. Respondents participated in in-depth, semi-structured interviews including questions on users’ perceived familial, social, and environmental influences of meth use. 

Gender-based themes emerged from the analysis: 

1. patterns of meth use; 
2. places where drugs were used; 
3. effects of relationship networks on meth use; 
4. differential access to drugs; 
5. trading sex for drugs; 
6. perceived class differences; and 
7. long-term drug use and its consequences. 

Respondents reported a preference for using meth as powder or pills as opposed to smoking or injecting the drug. They reported being introduced to meth by men they trust and relying on men for drug acquisition in spaces less accessible and more dangerous to women. 

They described how the drug changed their lifestyle and their behavior towards family members and friends, including instances of physical and psychological violence. Interventions for women on the Mexico-U.S. border should be developed based on users’ social networks to target social processes to prevent initiation and to bring active meth users into treatment.

Purchase full article at:   http://goo.gl/3HQjNt

By:   Oralia Loza^a*, Rebeca Ramos^b, João Ferreira-Pinto^a, Maria Teresa Hernandez^c & Susana A. Villalobos^d

• ^a College of Health Sciences, University of Texas at El Paso, El Paso, TX
• ^b Alliance of Border Collaboratives (ABC), El Paso, TX
• ^c School of Public Health, University of California, Berkeley, CA
• ^d Department of Emergency Medicine, Texas Tech Health Sciences of El Paso, Paul Foster School of Medicine, El Paso, TX

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Social Support and Adherence for Military Veterans with Hepatitis C

PURPOSE/OBJECTIVES:

The aim of this study was to describe military veterans' experiences of support and how those experiences influence their decisions to be adherent, during hepatitis C virus (HCV) treatment.

DESIGN:

A qualitative phenomenological design was used. Inclusion criteria were veterans 18 years or older, receiving standard treatment for HCV, able to read, write, and communicate in English.

SETTING:

A US Veterans Administration facility in Texas.

METHODS:

Data collection consisted of 1-time, in-depth interviews with analysis occurring simultaneously. Follow-up phone calls with participants verified that the themes were accurate reflections of their lived experience.

RESULTS:

Because of the fear of stigma, veterans make choices about to whom they tell their diagnosis. This limits the circle of friends and coworkers who could provide support. For some veterans, family members provide emotional and practical support, but family can also be a burden. In order to cope with family and treatment demands, some veterans hibernate, whereas others socialize with friends and coworkers. Some veterans found providers to be supportive, but others did not.

CONCLUSIONS:

Veterans experience both supportive and unsupportive reactions from family, friends, and healthcare providers while receiving HCV treatment. Those reactions either support or frustrate efforts to be adherent to treatment.

IMPLICATIONS:

In order to support treatment adherence, healthcare providers need to assess sources of support, or burden, experienced by military veterans during HCV treatment. When veterans do not have a supportive network, they need to be encouraged to attend a support group or seek counseling. Support services need to be funded by the Veterans Administration. Providers need to practice empathy and caring in order to support adherence during treatment. Further research is needed on how military veterans manage their health after hepatitis C treatment, contrasting successful versus unsuccessful treatment outcomes.

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By:  Phillips FH1, Barnes D.

• 1Author Affiliations: Clinical Assistant Professor (Dr Phillips) and Associate Professor (Dr Barnes), College of Nursing and Health Innovations, University of Texas at Arlington. 

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The Incarceration Rate for US Women Is Higher Than Anywhere Else

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A Survey of Texas HIV, Sexually Transmitted Disease, Tuberculosis, and Viral Hepatitis Providers' Billing and Reimbursement Capabilities

The Affordable Care Act presents financial challenges and opportunities for publicly funded service providers. 

We assessed billing practices and anticipated barriers to third-party billing among organizations in Texas that provide publicly funded HIV, sexually transmitted diseases, tuberculosis, and viral hepatitis services. 

• One third to one half of the organizations did not bill for medical services. 
• The most common barrier to third-party billing was lack of staff knowledge about billing and coding. 

Future research must evaluate options for organizations and communities to maintain access to infectious disease services for vulnerable populations. 

Purchase full article at: http://goo.gl/W7b4OW

By: Flynn MB1, Atwood R1, Greenberg JB1, Ray T1, Kaye Harris K1.

• 1Matthew B. Flynn is with the Department of Sociology and Anthropology, Georgia Southern University. Robin Atwood, Jennifer B. Greenberg, Tara Ray, and Karol Kaye Harris are with the Department of Kinesiology and Health Education, The University of Texas at Austin.  

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