Human Papillomavirus Infections in the Southern and Other United States Regions

Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide and has been linked to several cancers, including cervical cancer. In the United States, the Southern region has a disproportionate burden of cervical cancer, and research about the epidemiology of HPV in the region is scarce. This study estimates the prevalence and correlates of HPV infection among 14–59 year-old females. Data from 4,250 females aged 14–59 years collected during the 2007–2010 National Health and Nutrition Examination Survey (NHANES) were used. We estimated the prevalence of HPV infection for the South and the rest of the country. We performed weighted chi-square test and logistic regression to examine the association between HPV infection and various demographics. Among 14–26 year-old females, the prevalence of high-risk oncogenic HPV types was 25.6% (95% confidence (CI): 22.4 ̶ 33.3) in the South and 29.1% (95% CI: 24.8 ̶ 33.8) in the rest of the country (p= 0.15). Among 27–59 year-old women, infection from high-risk oncogenic types was 20.9% (95% CI: 17.4 ̶ 24.9) in the South compared to 14.5% (95% CI: 12.9 ̶ 16.3) in the rest of the country (p=0.0001). This study found a higher prevalence of infection from high-risk oncogenic types among 27 ̶ 59 year-old females in the South compared to the rest of the country, but not among the 14 ̶ 26 year-olds. These findings highlight the importance of promoting HPV vaccination as well as cervical cancer screening, particularly in the Southern region

Black–White Latino Racial Disparities in HIV Survival, Florida, 2000–2011

This research aimed to estimate Black/White racial disparities in all-cause mortality risk among HIV-positive Latinos. Florida surveillance data for Latinos diagnosed with HIV (2000–2008) were merged with 2007–2011 American Community Survey data. Crude and adjusted hazard ratios (aHR) were calculated using multi-level Cox regression. Of 10,903 HIV-positive Latinos, 8.2% were Black and 91.9% White. Black Latinos were at increased mortality risk compared with White Latinos after controlling for individual and neighborhood factors (aHR 1.40, 95% confidence interval (CI) 1.21–1.62). In stratified analyses, risk factors for Black Latinos included: age ¥60 years compared with ages 13–19 (aHR 4.63, 95% CI 1.32–16.13); US birth compared with foreign birth (aHR 1.56, 95% CI 1.16–2.11); diagnosis of AIDS within three months of HIV diagnosis (aHR 3.53, 95% CI 2.64–4.74); residence in the 3rd (aHR 1.82, 95% CI 1.13–2.94) and 4th highest quartiles (aHR 1.79, 95% CI 1.12–2.86) of neighborhood poverty compared with the lowest quartile; and residence in neighborhood with 25%–49% (aHR 1.59, 95% CI 1.07–2.42) and ¥50% Latinos compared with \u3c25% Latinos (aHR 1.58, 95% CI 1.03–2.42). Significant racial disparities in HIV survival exist among Latinos. Differential access to—and quality of—care and perceived/experienced racial discrimination may be possible explanations

Neighborhood Latino ethnic density and mortality among HIV- positive Latinos by birth country/region, Florida, 2005–2008

OBJECTIVE: Lower mortality for Latinos has been reported in high Latino density areas. The objective was to examine the contribution of neighborhood Latino density to mortality among HIV-positive Latinos. METHODS: Florida HIV surveillance data for 2005–2008 were merged with 2007–2011 American Community Survey data using zip code tabulation areas. Hazard ratios (HR) were calculated using multi-level weighted Cox regression and adjusted for individual-level factors and neighborhood poverty. RESULTS: Of 4649 HIV-positive Latinos, 11.8% died. There was no difference in mortality risk across categories of Latino ethnic density for Latinos as a whole. There were subgroup effects wherein mortality risk differed by ethnic density category for Latinos born in some countries/regions. Residing in an area with ≥50% Latinos compared with <25% was associated with increased mortality risk for Latinos born in Puerto Rico (HR 1.67; 95% CI [1.01–2.70]). Residing in an area where Mexicans were the majority Latino group was associated with increased mortality risk for Latinos born in Mexico (HR 3.57; 95% CI [1.43–10.00]). CONCLUSIONS: The survival advantage seen among the Latino population in high Latino density areas was not seen among HIV-positive Latinos. Research is needed to determine if this may be related to stigma or another mechanism

Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000–2011

BACKGROUND: The objectives are to examine disparities in all-cause mortality risk among HIV-positive Latinos with injection drug use (IDU) history, and to identify individual- and neighborhood-level predictors. METHODS: Florida surveillance data for persons diagnosed with HIV 2000–2008 were merged with 2007–2011 administrative data from the American Community Survey. Hazard ratios (HR) were calculated using multi-level weighted Cox regression adjusting for individual and neighborhood (ZCTA-level) factors. RESULTS: Of 10,989 HIV-positive Latinos, 10.3% had IDU history. Latinos with IDU history were at increased mortality risk compared with Latinos without IDU history after controlling for individual and neighborhood factors (adjusted HR [aHR] 1.61, 95% confidence interval [CI] 1.43–1.80). Factors associated with mortality for those with IDU history included: being 40–59 (aHR 6.48, 95% CI 1.41–121.05) and ≥60 years (aHR 18.75, 95% CI 3.83–356.45) compared with 13–19 years of age; being diagnosed with AIDS within 3 months of HIV (aHR 2.31, 95% CI 1.87–2.86); residing in an area with ≥50% Latinos compared with <25% Latinos (aHR 1.56, 95% CI 1.19–2.04); and residing in a rural compared with an urban area at the time of diagnosis (aHR 1.73, 95% CI 1.06–2.70). Race and neighborhood poverty were not predictors among those with IDU, but were among those without. CONCLUSION: HIV-positive Latinos with IDU history are at increased mortality risk and have unique contributing factors. Tertiary prevention strategies should target those who are older, diagnosed at later stages, and those who live in predominantly Latino and rural areas

A Brief Report: Lessons Learned and Preliminary Findings of Progreso en Salud, an HIV Risk Reduction Intervention for Latina Seasonal Farmworkers

Throughout the past decade, HIV rates in Florida?particularly South Florida, where many Latina seasonal farmworkers reside and work?have ranked among the highest in the nation. In this brief report, we delineate important lessons learned and preliminary findings from the implementation of the HIV prevention intervention Progreso en Salud (Progress in Health). Among the 114 Latina seasonal farmworker participants, there were significant increases from baseline to 6-month follow-up in the percentages of overall condom use, HIV testing, HIV/AIDS-related communications with friends, HIV knowledge, condom use self-efficacy, and correct use of condoms. Lessons learned from this study can be used to inform future HIV intervention strategies to improve the adoption and maintenance of HIV risk reduction behaviors among high-risk Latina seasonal workers and other high-risk underserved populations. Future research is needed to support our findings

Provider Perceptions of Barriers to HIV Care Among Women with HIV in Miami-Dade County, Florida, and Possible Solutions: A Qualitative Study

In Miami-Dade County, women with HIV (WWH) enrolled in Ryan White Program (RWP) services belong to groups that have historically faced structural barriers to care. To examine provider perceptions of WWH\u27s barriers to care and elicit possible solutions, we conducted semi-structured interviews (n = 20) with medical case managers and human immunodeficiency virus (HIV) healthcare providers from medical case management sites serving WWH enrolled in the Miami-Dade RWP. Verbatim transcripts were analyzed thematically by two coders through an iterative process; disagreements were resolved through consensus. Barriers included lack of disclosure and stigma, additional psychosocial barriers to care, structural and logistical barriers, and negative interactions with health care providers. Participant suggestions to address these barriers included strategies that support women and foster individualized services that are responsive to their lived experiences and needs. Other solutions, such as those related to transportation, housing, and general funding for the RWP, will require advocacy and policy change

Development and validation of vulnerable and enabling indices for hiv viral suppression among people with hiv enrolled in the ryan white program

Background: Numerous factors impact HIV care, often requiring consideration of indices to prevent collinearity when using statistical modeling. Using the Behavioral Model for Vulnerable Populations, we developed vulnerable and enabling indices for people living with HIV (PLWH). Methods: We used Ryan White Program (RWP) data and principal component analysis to develop general and gender-and racial/ethnic-specific indices. We assessed internal reliability (Cronbach’s alpha), convergent validity (correlation coefficient), and predictive utility (logistic regression) with non-viral suppression. Results: Three general factors accounting for 79.2% of indicators’ variability surfaced: mental health, drug use, and socioeconomic status (Cronbach’s alpha 0.68). Among the overall RWP population, indices showed convergent validity and predictive utility. Using gender-or racial/ethnic-specific indices did not improve psychometric performance. Discussion: General mental health, drug use, and socioeconomic indices using administrative data showed acceptable reliability, validity, and utility for non-viral suppression in an overall PLWH population and in gender-and racial/ethnic-stratified populations. These general indices may be used with similar validity and utility across gender and racial/ethnic diverse populations

Building a diverse workforce and thinkforce to reduce health disparities

The Research Centers in Minority Institutions (RCMI) Program was congressionally man-dated in 1985 to build research capacity at institutions that currently and historically recruit, train, and award doctorate degrees in the health professions and health-related sciences, primarily to individuals from underrepresented and minority populations. RCMI grantees share similar infrastructure needs and institutional goals. Of particular importance is the professional development of multidisciplinary teams of academic and community scholars (the “workforce”) and the harnessing of the heterogeneity of thought (the “thinkforce”) to reduce health disparities. The purpose of this report is to summarize the presentations and discussion at the RCMI Investigator Development Core (IDC) Workshop, held in conjunction with the RCMI Program National Conference in Bethesda, Maryland, in December 2019. The RCMI IDC Directors provided information about their professional development activities and Pilot Projects Programs and discussed barriers identified by new and early-stage investigators that limit effective career development, as well as potential solutions to overcome such obstacles. This report also proposes potential alignments of professional development activities, targeted goals and common metrics to track productivity and success