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Treatment Outcomes in Undocumented Hispanic Immigrants with HIV Infection  [PDF]
Kenneth K. Poon, Bich N. Dang, Jessica A. Davila, Christine Hartman, Thomas P. Giordano
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0060022
Abstract: Objective Little is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care. Methods We conducted a retrospective cohort study of antiretroviral-naive patients 18 years and older attending their first visit at Thomas Street Health Center in Houston, Texas, between 1/1/2003 and 6/30/2008. The study population of 1,620 HIV-infected adults included 186 undocumented Hispanic, 278 documented Hispanic, 986 Black, and 170 White patients. The main outcome measures were retention in care (quarter years with at least one completed HIV primary care provider visit) and HIV suppression (HIV RNA <400 copies/mL), both measured 12-months after entering HIV care. Results Undocumented Hispanic patients had lower median initial CD4 cell count (132 cells/mm3) than documented Hispanic patients (166 cells/mm3; P = 0.186), Black patients (226 cells/mm3; P<0.001), and White patients (264 cells/mm3; P = 0.001). However, once in care, undocumented Hispanic patients did as well or better than their documented counterparts. One year after entering HIV care, undocumented Hispanics achieved similar rates of retention in care and HIV suppression as documented Hispanic and White patients. Of note, black patients were significantly less likely to have optimal retention in care (adjusted odds ratio [aOR] 0.65, CI = 0.45–0.94) or achieve HIV suppression (aOR 0.32, CI = 0.17–0.61) than undocumented Hispanics. Conclusions Undocumented Hispanic persons with HIV infection enter care with more advanced disease than documented persons, suggesting testing and/or linkage to care efforts for this difficult-to-reach population need intensification. Once diagnosed, however, undocumented Hispanics have outcomes as good as or better than other racial/ethnic groups. Safety net providers for undocumented immigrants are vital for maintaining individual and public health.
HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention  [cached]
McMahon Tadgh,Ward Paul R
Systematic Reviews , 2012, DOI: 10.1186/2046-4053-1-56
Abstract: Background Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention. Methods We undertook a realist review to answer the research question: ‘How are HIV prevention interventions in high-income countries adapted to suit immigrants’ needs?’ A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms. Results Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of ‘consonance’ mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms – ‘understanding’, ‘specificity’ and ‘embeddedness’ – which indicated that using the language of immigrants, usually the ‘mother tongue’, targeting (in terms of ethnicity) and the use of settings were also critical elements in culturally appropriate HIV prevention. There was mixed evidence for the roles of ‘authenticity’ and ‘framing’ mechanisms and only partial evidence to support role of ‘endorsement’ mechanisms. Conclusions This realist review contributes to the explanatory framework of behavioural HIV prevention among immigrants living in high-income countries and, in particular, builds a greater understanding of the suite of mechanisms that underpin adaptations of interventions by the cultural context and population being targeted.
How to improve the health of undocumented Latino immigrants with HIV in New Orleans: an agenda for action
Ruiz,Marco; Briones-Chavez,Carlo Sebastian;
Revista Panamericana de Salud Pública , 2010, DOI: 10.1590/S1020-49892010000700010
Abstract: latino communities continue to grow in the united states. these communities are significantly affected by hiv infection. new orleans is a city whose demographics have changed since hurricane katrina in 2005, as numerous latinos/hispanics came to the city to help rebuild it. this population might have a higher risk of hiv acquisition and problems with access to health care. data on hiv infection in these populations are insufficient. active community participation and commitment of key stakeholders are important for developing strategies to bring about change. political and social support is also a major determinant of any potential change. the following were common ground points after meetings with key stakeholders: (1) to analyze and diagnose health situations in documented and undocumented communities with hiv/aids in the city of new orleans; (2) to develop partnerships and networks among stakeholders with a significant presence in latino/hispanic communities in the city; (3) to strengthen research in latino/hispanic community issues among research centers, academicians, and health care services; (4) to investigate the development of prevention strategies and technical innovations; (5) to advocate strategies to improve health care access among documented and undocumented immigrants. this project will report additional findings soon.
Dietary acculturation of Hispanic immigrants in Mississippi
Gray,Virginia B.; Cossman,Jeralynn S.; Dodson,Wanda L.; Byrd,Sylvia H.;
Salud Pública de México , 2005, DOI: 10.1590/S0036-36342005000500005
Abstract: objective: assisting hispanic immigrants in making culturally acceptable food choices may affect their health for generations. as a relatively new enclave of hispanics, scott county, mississippi, was chosen to study dietary acculturation and health concerns of immigrants. material and methods: the research method consisted of interviews with community representatives (n=11), a focus group (n=6), and interviews with hispanic immigrants (n=18). results: community representatives mentioned availability influenced immigrants' food choices and suggested promoting cultural awareness and offering nutrition classes on local ingredients. food cost, health concepts, food selection, and eating habits of children were salient themes from the focus group and interviews with hispanics. hispanic participants mentioned long work hours affect food selection and that us produce lacks freshness and flavor. conclusions: results indicate that an intervention must be formulated that preserves healthful dietary practices and minimizes the negative health aspects of acculturation to the "american diet."
Weight-Loss Interventions for Hispanic Populations: The Role of Culture  [PDF]
Nangel M. Lindberg,Victor J. Stevens,Ruben O. Halperin
Journal of Obesity , 2013, DOI: 10.1155/2013/542736
Abstract: In the United States, ethnic minorities are overrepresented among the overweight and obese population, with Hispanic individuals being among the groups most at risk for obesity and obesity-related disease and disability. Most weight-loss interventions designed for the general population have been less successful with individuals from ethnic minorities and there is a pressing need to develop more effective interventions for these groups. This paper examines the importance of culture in the development of “culturally competent” weight-loss interventions for ethnic minority populations, and discusses specific culturally mediated factors that should be considered in the design and implementation of treatment interventions. While specifically focusing on Hispanic populations, we also address issues of relevance to other multiethnic societies. 1. Introduction The harmful consequences of obesity have been well documented: obesity increases overall mortality [1–3], decreases life expectancy [4], and is an important risk factor for diabetes and cardiovascular disease, and many other conditions [5–9]. Obesity and its consequences disproportionately affect ethnic minority communities [10–13], with individuals of Hispanic origin, particularly Mexican-Americans, among the groups at highest risk [5, 14–17]. In the United States, newly arrived immigrants from Spanish-speaking countries are generally healthier than the U.S.-born Hispanic population, but as their duration of residency increases, so does the prevalence of poor health behaviors [18, 19], including the adoption of high-fat, low-fiber diets [20]. As a consequence, there is a linear association between obesity and length of residence in the United States for Mexican immigrants; those with 15 years or longer of residence have a fourfold greater risk of obesity compared to those who have been here for less than 5 years [20]. 2. Diet, Culture, and Weight Loss Culture is intimately tied to diet. It has been suggested that there is perhaps no better way to understand a culture, its values, preoccupations, and fears than by examining its attitudes toward food [21]. Food not only provides daily sustenance but also provides a core element which bonds families and communities and provides a common element to mark rites of passage and celebrations. Selection of ingredients, how foods are prepared, the timing and context of meals, size of portions, notions of healthful versus unhealthy foods, and what is considered a “meal” and what is considered a “snack,” are all integral parts of cultural patterns. Dietary patterns
Acceptability of Mobile Phone Technology for Medication Adherence Interventions among HIV-Positive Patients at an Urban Clinic  [PDF]
Christopher W. T. Miller,Seth Himelhoch
AIDS Research and Treatment , 2013, DOI: 10.1155/2013/670525
Abstract: Mobile phone technology is increasingly used to overcome traditional barriers limiting access to care. The goal of this study was to evaluate access and willingness to use smart and mobile phone technology for promoting adherence among people attending an urban HIV clinic. One hundred consecutive HIV-positive patients attending an urban HIV outpatient clinic were surveyed. The questionnaire evaluated access to and utilization of mobile phones and willingness to use them to enhance adherence to HIV medication. The survey also included the CASE adherence index as a measure of adherence. The average age was 46.4 ( ). The majority of participants were males (63%), black (93%), and Hispanic (11.4%) and reported earning less than $10,000 per year (67.3%). Most identified themselves as being current smokers (57%). The vast majority reported currently taking HAART (83.5%). Approximately half of the participants reported some difficulty with adherence (CASE < 10). Ninety-six percent reported owning a mobile phone. Among owners of mobile phones 47.4% reported currently owning more than one device. Over a quarter reported owning a smartphone. About 60% used their phones for texting and 1/3 used their phone to search the Internet. Nearly 70% reported that they would use a mobile device to help with HIV adherence. Those who reported being very likely or likely to use a mobile device to improve adherence were significantly more likely to use their phone daily ( ) and use their phone for text messages ( ). The vast majority of patients in an urban HIV clinic own mobile phones and would use them to enhance adherence interventions to HIV medication. 1. Introduction Optimal adherence to HAART strongly predicts HIV viral suppression [1] and is linked to improved survival [2]. Low adherence to HAART in the United States is common with approximately only 50%–70% of prescribed doses taken [3, 4]. One meta-analysis found that those who participated in HAART-related adherence-enhancing interventions were significantly more likely to achieve 95% adherence and viral load suppression compared to the control condition [5]. A recent systematic review analyzed findings from 31 projects assessing use of SMS (short message service) technology, most for patients with HIV/AIDS in developing countries [6]; the findings pointed towards SMS as a promising and mostly well-accepted intervention strategy for use in healthcare. The utilization of technology-based health applications for disease prevention and management has been progressively explored and expanded upon [7–11]. Promising
Advances in the prevention of heterosexual transmission of HIV/AIDS among women in the United States  [cached]
Nadine E. Chen,Jaimie P. Meyer,Sandra A. Springer
Infectious Disease Reports , 2011, DOI: 10.4081/idr.2011.e6
Abstract: Despite recent advances in testing and treatment, the incidence of HIV/AIDS in the United States has remained stagnant with an estimated 56,300 new infections every year. Women account for an increasing proportion of the epidemic. The vulnerability of women to HIV stems from both increased biologic susceptibility to heterosexual transmission and also the social, economic, and structural disadvantages they often confront. This review describes the main reasons for the increased vulnerability of U.S. women to HIV transmission with particular emphasis on specific high-risk groups including: non-Hispanic blacks, women who use drugs, women with a history of incarceration, and victims of intimate partner violence. Although behavioral approaches to HIV prevention may be effective, pragmatic implementation is often difficult, especially for women who lack sociocultural capital to negotiate condoms with their male partners. Recent advances in HIV prevention show promise in terms of female-initiated interventions. These notably include female condoms, non-specific vaginal microbicides, and antiretroviral oral and vaginal pre-exposure prophylaxis. In this review, we will present evidence in support of these new female-initiated interventions while also emphasizing the importance of advocacy and the political support for these scientific advances to be successful.
HIV/AIDS practice patterns, knowledge, and educational needs among Hispanic clinicians in Texas, USA, and Nuevo Leon, Mexico
Martinez,J. Louis; Licea Serrato,Juan de Dios; Jimenez,Richard; Grimes,Richard M.;
Revista Panamericana de Salud Pública , 1998, DOI: 10.1590/S1020-49891998000700003
Abstract: hispanic clinicians in texas, united states of america, and in the neighboring state of nuevo leon, mexico, were surveyed to determine their educational needs in the area of hiv/aids. two-thirds of the 74 texan and 22% of the 104 mexican physicians queried had seen at least one hiv/aids patient in the previous year. the majority of the respondents were primary care physicians who: 1) were in private practice; 2) saw more than 1 000 patients per year; 3) had been out of training for more than 10 years; 4) provided some hiv prevention education to patients based on their perceived risk of infection; 5) rated their own knowledge of hiv/aids as average but rated their knowledge of treatments for the disease below average; 6) received most of their information about hiv/aids from journals rather than formal continuing education programs; 7) thought hispanic patients had special needs with regard to hiv/aids care; and 8) were willing to attend education programs to improve their hiv/aids management skills. the greatest barriers to caring for hiv patients were lack of clinical knowledge and fear of infection. these results point to a need for a large-scale training program to improve the hiv/aids management skills of hispanic clinicians in texas and nuevo leon.
HIV/AIDS practice patterns, knowledge, and educational needs among Hispanic clinicians in Texas, USA, and Nuevo Leon, Mexico  [cached]
Martinez J. Louis,Licea Serrato Juan de Dios,Jimenez Richard,Grimes Richard M.
Revista Panamericana de Salud Pública , 1998,
Abstract: Hispanic clinicians in Texas, United States of America, and in the neighboring state of Nuevo Leon, Mexico, were surveyed to determine their educational needs in the area of HIV/AIDS. Two-thirds of the 74 Texan and 22% of the 104 Mexican physicians queried had seen at least one HIV/AIDS patient in the previous year. The majority of the respondents were primary care physicians who: 1) were in private practice; 2) saw more than 1 000 patients per year; 3) had been out of training for more than 10 years; 4) provided some HIV prevention education to patients based on their perceived risk of infection; 5) rated their own knowledge of HIV/AIDS as average but rated their knowledge of treatments for the disease below average; 6) received most of their information about HIV/AIDS from journals rather than formal continuing education programs; 7) thought Hispanic patients had special needs with regard to HIV/AIDS care; and 8) were willing to attend education programs to improve their HIV/AIDS management skills. The greatest barriers to caring for HIV patients were lack of clinical knowledge and fear of infection. These results point to a need for a large-scale training program to improve the HIV/AIDS management skills of Hispanic clinicians in Texas and Nuevo Leon.
Number of casual male sexual partners and associated factors among men who have sex with men: Results from the National HIV Behavioral Surveillance system
Eli S Rosenberg, Patrick S Sullivan, Elizabeth A DiNenno, Laura F Salazar, Travis H Sanchez
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-189
Abstract: Data are from the first MSM cycle of the National HIV Behavioral Surveillance system, conducted from 2003 to 2005. Relationships between number of casual male sex partners within the previous year and demographic information, self-reported HIV status, and risk behaviors were determined through regression models.Among 11,191 sexually active MSM, 76% reported a casual male partner. The median casual partner number was three. Lower number of casual partners was associated with black race, Hispanic ethnicity, and having a main sex partner in the previous year. Factors associated with a higher number included gay identity, exchange sex, both injection and non-injection drug use. Being HIV-positive was associated with more partners among non-blacks only. Age differences in partner number were seen only among chat room users.MSM who were black, Hispanic or had a main sex partner reported fewer casual sex partners. Our results suggest specific populations of MSM who may benefit most from interventions to reduce casual partner numbers.Men who have sex with men (MSM) have consistently been the most heavily impacted risk group in the US HIV epidemic. Recent evidence confirms that MSM in the United States [1] and in other industrialized countries [2] are experiencing a resurgence in HIV transmissions since at least 2000. In the United States, MSM of color, especially younger MSM, are particularly affected in terms of new HIV infections in recent years [3].The reasons for racial/ethnic disparities in HIV infection are unclear, but it is likely that these disparities are explained by a complex set of behavioral, network, structural and, perhaps, biological factors [4,5]. Understanding trends in behavioral risks, and how these risks differ in subpopulations of MSM, is critical to design and disseminate HIV prevention programs to curb new HIV transmissions. A number of behavioral factors are important to HIV transmission patterns in MSM, including numbers and types of sex partners,
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