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OBJECTIVES: To explore the health impacts of Hurricane Maria (HM) on HIV care outcomes among people living with HIV who use drugs. METHODS: Using data from an ongoing cohort study in San Juan, Puerto Rico (Proyecto PACTo), we measured differences in HIV care outcomes (viral load, viral suppression, and CD4 counts) before and after HM using assessments conducted at 6-month intervals. Generalized estimating equations were used to assess factors associated with HIV care outcomes. RESULTS: All HIV care outcomes showed a deterioration from pre-HM values to post-HM values (mean viral load increased, CD4 counts decreased, and rate of viral suppression decreased) after controlling for pre-HM sociodemographic and health characteristics. In addition to HM, age (aIRR = 1·01), being homeless (aIRR = 0·78) and having health insurance (aIRR = 1·6) were independently associated with viral suppression. PARTICIPANTS: 219 participants completed follow-up visits between April 2017 and January 2018, before and after HM. CONCLUSIONS: People living with HIV who use drugs in Puerto Rico experienced poorer HIV outcomes following HM. Socio-environmental factors contributing to these outcomes is discussed in the context of disaster response, recovery, and program planning.
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Tempestades Ciclônicas , Desastres , Infecções por HIV , Humanos , Porto Rico , Estudos de CoortesRESUMO
Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019âJanuary 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumatic stress disorder), and HIV outcomes (e.g., viral load, antiretroviral therapy adherence). Neighborhood characteristics by census tract were gathered from the American Community Survey and the National Center for Charitable Statistics. Spatial econometrics guided the identification strategy, and we used the maximum likelihood technique to estimate relationships between a number of predictors and outcomes. Results. Within-neighborhood and neighboring characteristics (employment, education, crime, income, number of religious organizations, and low-income housing) were significantly related to intersectional stigma, discrimination, mental health, HIV viral load, and medication adherence. Conclusions. Policy, research, and interventions for BWLWH need to address the role of neighborhood characteristics to improve quality of life and HIV outcomes. (Am J Public Health. 2022;112(S4):S433-S443. https://doi.org/10.2105/AJPH.2021.306675).
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Infecções por HIV , Saúde Mental , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Características da Vizinhança , Qualidade de Vida , Sudeste dos Estados Unidos/epidemiologiaRESUMO
In this work, the biosorption behavior of acid red 27 (AR27) dye using Eichhornia crassipes leaves (LECs) in a packed-bed column was investigated by varying relevant operational parameters and assessment of mathematical models. Results showed that the zero-charge point of LECs was 2.37 and that optima pH and volumetric flux of the influent solution for AR27 biosorption were 2.0 and [Formula: see text], respectively. The maximum specific and volumetric biosorption capacities were observed at influent AR27 concentrations and with LEC bed heights ranging between 50 and 400 mg/L and 2 and 8 cm, respectively. It was also found that if LEC bed height was increased and volumetric flux and AR27 concentration of the influent solution decreased, service and saturation time increased. Modeling results revealed that the Thomas, bed depth service time, Yoon-Nelson, dose-response, and logistic models accurately described the dynamic performance of the packed-bed column in terms of pH, AR27 concentration, and volumetric flux of influent AR27 solution, as well as that of LEC bed height. The findings revealed that LECs exhibited remarkable potential for the biosorption of AR27 from aqueous solutions in a packed-bed column and could potentially be useful for the treatment of AR27-laden wastewater.
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Introducción: Las mujeres transgénero (MT) son vulnerables a diversos problemas de salud, incluyendo el virus de la inmunodeficiencia humana (VIH) y otras infecciones de transmisión sexual (ITS), que reducen significativamente su expectativa de vida. Consecuentemente, existe la necesidad de entender los factores que afectan su acceso a la salud.Métodos: Se realizó una investigación cualitativa en MT que viven en alojamientos comunitarios (HT, hoteles trans) en Buenos Aires. El objetivo del estudio fue explorar las barreras y facilitadores contextuales, sociales e individuales para el acceso a la salud, particularmente los servicios de VIH, y la aceptabilidad de diferentes intervenciones. Se realizaron dos grupos focales y cinco entrevistas en tres hoteles trans.Resultados: Las barreras contextuales descriptas fueron los turnos limitados y las largas horas de espera. Los obstáculos sociales incluyeron el estigma y la discriminación por parte del personal y la culpabilización de las MT de sus problemas de salud, así como el estigma por VIH dentro de los grupos de MT. El facilitador más importante fueron los servicios inclusivos. Las barreras individuales incluyeron la auto-exclusión y el estigma anticipado, resultando en altos índices de automedicación e inyección de siliconas. Las pares juegan un rol importante acompañando a otras MT a los servicios. Aun reportando problemas similares, las MT recomendaron intervenciones diferentes según su perfil de hotel. Conclusiones: Dado que el estigma y la discriminación son la principal barrera, es imprescindible sensibilizar a todo el personal de salud. Se necesita implementar una amplia gama de estrategias en los establecimientos de salud y evaluar la aceptación de intervenciones domiciliarias para responder a las diferentes demandas de las MT
Background: Transgender women (TGW) are vulnerable to several health problems, including HIV and other STDs, which significantly reduces their life expectancy. Therefore, there is an urgent need to understand factors affecting access to healthcare.Methods: A qualitative study was conducted among TGW living in rooming houses (TRH) in Buenos Aires. The objective of the study was to explore contextual, social and individual barriers and facilitators to access healthcare, particularly HIV services, and the acceptability of interventions. Two focus groups and five interviews were conducted in three TRH.Results: Contextual barriers described were the limited number of appointments and long waiting hours. Social obstacles included health workers' stigma and discrimination and blaming of TGW for their health burdens, as well as HIV stigma within TGW groups. Most important facilitator were inclusive services. Individual barriers were self-exclusion and anticipated stigma, resulting in high rates of self-medication and industrial silicone injection. Peers play an important role by accompanying others TGW to healthcare. While reporting similar problems, TGW recommended different interventions according to their THR profile. Conclusions: As the stigma and discrimination is the most important barrier, it is imperative to ensure awareness of transgender issues for all personnel of healthcare services. It is necessary to implement a wide range of strategies in health facilities, and evaluate the community acceptance of domiciliary interventions, in order to respond to the different demands of this population
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Humanos , Feminino , Adulto , Isolamento Social , Infecções Sexualmente Transmissíveis/terapia , Coleta de Dados , HIV/imunologia , Alojamento , Estudos de Avaliação como Assunto , Estigma Social , Sexismo , Pessoas Transgênero , Acesso Efetivo aos Serviços de Saúde , Política de SaúdeRESUMO
BACKGROUND: Substance use, particularly injection drug use, continues to fuel the HIV/HCV (hepatitis C virus) epidemics in San Juan, Puerto Rico (PR). AIM: This article examines individual and sociostructural factors that affect HIV/HCV risk among people who use drugs (PWUD) living with or at risk for HIV/HCV in San Juan, PR. Findings were used to inform a community-level intervention to enhance HIV care access and retention for this population. METHOD: A rapid ethnographic assessment in collaboration with a community-based organization was conducted. Data collection took place between June and December 2013 and included field observations, 49 unstructured interviews with PWUD, and 19 key informant interviews with community stakeholders. Fieldnotes, photographs, and interview transcripts were analyzed for recurrent themes and to address the intervention-planning needs. Study results are presented as fieldnote excerpts, direct quotes from interviews, and photographs. RESULTS: Findings suggest that PWUD in PR face myriad challenges that affect HIV/HCV risk and hinder linkage to and retention in care. Results describe a layered risk environment where PWUD encounter many barriers to prevention, care, and treatment such as transience, social isolation, stigma, limited housing options, and inadequate medical and substance use disorder treatment services. DISCUSSION: These observed circumstances provide an empirical basis for the development and evaluation of comprehensive interventions that may serve to reduce barriers to care and link individuals to other supportive services. CONCLUSION: New approaches and comprehensive interventions are needed to break the structures that perpetuate risk and lack of engagement and retention in HIV care and substance use disorder treatment in San Juan.
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Usuários de Drogas , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Abuso de Substâncias por Via Intravenosa , Adulto , Antropologia Cultural , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico , Assunção de Riscos , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
BACKGROUND: HIV prevalence in Puerto Rico is nearly twice that of the mainland United States, a level that was substantially fueled by injection drug use. Puerto Rico has a longstanding history of health provision by the public sector that directly affects how HIV and substance use disorder (SUD) treatment services are provided and funded. As part of pre-implementation research for a randomized trial of a community-level intervention to enhance HIV care access for substance users in San Juan, Puerto Rico, we sought to understand the structural and health policy environment for providing HIV and SUD treatments. METHODS: We conducted semi-structured qualitative interviews (n = 8) with government and program administrators in English and Spanish. Data were analyzed to identify dominant and recurrent themes. RESULTS: Participants discussed how lack of integration among medical and mental health service providers, lack of public transportation, and turnover in appointed government officials were barriers to integrated HIV and SUD treatment. Federal funding for support services for HIV patients was a facilitator. The Affordable Care Act has limited impact in Puerto Rico because provisions related to health insurance reform do not apply to U.S. territories. DISCUSSION AND CONCLUSIONS: Implications for intervention design include the need to provide care coordination for services from multiple providers, who are often physically separated and working in different reimbursement systems, and the potential for mobile and patient transportation services to bridge these gaps. Continuous interaction with political leaders is needed to maintain current facilitators. These findings are relevant as the current economic crisis in Puerto Rico affects funding, and may be relevant for other settings with substance use-driven epidemics.
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Prestação Integrada de Cuidados de Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Política de Saúde , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Necessidades e Demandas de Serviços de Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , Serviços de Saúde Mental/organização & administração , Patient Protection and Affordable Care Act , Porto Rico , Abuso de Substâncias por Via Intravenosa/reabilitação , Estados UnidosRESUMO
Little is known about the use of HIV primary care among Haitian immigrants in the USA. The present study utilizes data from a survey of HIV-positive Haitians recruited from an HIV primary care clinic in Miami, Florida, to examine barriers and facilitators of regular use of HIV care by this population. Selection of measures was guided by the Andersen Model of Health Services Utilization for Vulnerable Populations. The dependent variable, regular use of HIV primary care, was operationalized as completion of four or more HIV primary care visits during the previous 12 months. Of the 96 participants surveyed, approximately three-fourths did not graduate from high school and reported an annual income of up to $5000. Seventy-nine percent of participants completed four or more visits in the past year. On univariate as well as multivariate analyses, participants without formal education or those with high psychological distress were significantly less likely to have used HIV primary care regularly than those who attended school or who were less distressed, respectively. The findings emphasize the need for health care practitioners to pay close attention to the education level and the mental health status of their Haitian HIV patients. The data also suggest that once these individuals are linked to care and offered assistance with their daily challenges, they are very likely to stay connected to care and to take their antiretroviral medicines.
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Infecções por HIV/terapia , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Feminino , Florida , Infecções por HIV/etnologia , Soropositividade para HIV/etnologia , Soropositividade para HIV/terapia , Haiti/etnologia , Acessibilidade aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
OBJECTIVES: To examine the HIV care needs and hospital admission patterns of HIV-positive Haitian-born blacks (Haitians) and compare them with those of US-born blacks (Blacks). METHODS: We abstracted the medical records of 635 Blacks and Haitians consecutively admitted to the adult HIV Service at Jackson Memorial Hospital during 2004 for information on demographics, use of antiretroviral therapy, CD4 cell counts, primary and secondary diagnoses at admission, and substance use. The probability of being prescribed highly active antiretroviral therapy (HAART) was examined by country of origin. RESULTS: There was no statistically significant difference between the groups in likelihood to be prescribed HAART. In controlled analyses, however, Haitians were 76% more likely than Blacks to have a CD4 count <51 cells/mm3 and tended to be more recently diagnosed with HIV Moreover, tuberculosis was the most prevalent opportunistic infection for Haitians compared with candidiasis for Blacks. CONCLUSIONS: Findings suggest that barriers to medical care may exist for Haitians at an early stage of the access continuum and that prevention efforts among the Haitian HIV-positive population should be directed at promoting the need for timely use of health services.
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Infecções Oportunistas Relacionadas com a AIDS/etiologia , Infecções por HIV , Hospitalização/tendências , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , População Negra , Contagem de Linfócito CD4/estatística & dados numéricos , Candidíase/etiologia , Feminino , Florida/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Hospitalização/estatística & dados numéricos , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose/etiologiaAssuntos
Humanos , Feminino , Idoso , Falso Aneurisma , Doença das Coronárias , Ecocardiografia Doppler em Cores , Costa RicaRESUMO
Objetivo: Evaluar la eficacia del danazol para el tratamiento de la trombocitopenia asociada con el virus de la inmunodeficiencia humana tipo 1 (HIV-1). Pacientes y Métodos: Estudio retrospectivo, diseño serie de casos. Se identificaron 8 pacientes con trombocitopenia asociada a infección con HIV-1 que fueron tratados con danazol (300-800 mg/día) por más de 3 meses. El seguimiento fue de 3 meses a 2 años. Se definió respuesta favorable al tratamiento como un incremento en el recuento de plaquetas por encima del 25 por ciento con referencia a los valores pre-tratamiento. Resultados: El recuento de plaquetas promedio(ñ desviación estándar) antes de la terapia con danazol fue de 51ñ24 x 10/L, con un rango de 19-88 x 10/L.Siete (87 por ciento) de los 8 pacientes tuvieron respuestas favorables al danazol. Los recuentos promedio a 12 y 24 meses de terapia fueron 104+108 x 10/L, y 112ñ28 x 10/L, respectivamente. Se observó una tendencia al incremento de los recuentos plaquetarios durante el tratamiento con danazol. Conclusión: Danazol puede ser de utilidad en el tratamiento de la trombocitopenia asociada a HIV-1.