Social Determinants of Health Associated with HBV Testing and Access to Care among Foreign-born Persons Residing in the United States: 2009 - 2012

Objectives: To describe how select Social Determinants of Health (SDH) are associated with the burden of hepatitis B virus (HBV) infection among foreign-born persons residing in the United States. Methods: Multivariate logistic regression was used to examine the Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey data to investigate the independent relationship between SDH and HBV testing and access to care. Results: HBV infected persons with insurance were more likely to see a physician than those without. Respondents worried about money to pay rent or mortgage were more likely to report HBV infection than individuals who reported they never worry. Compared to English speakers, Spanish-speakers were less likely to report HBV infection, Vietnamese-speakers were more likely to see a physician for HBV infection, and Khmer-speakers were less likely to be tested. Conclusions: Health insurance coverage, worries about paying rent, and language of interview all differentially affect HBV testing and linkages to care among foreign–born persons. Multi-sectorial stakeholder collaborative efforts should integrate resources to provide culturally sensitive health promotion campaigns which may improve HBV related outcomes

HIV and STI Risk for Young Blacks in High Prevalence Areas: Implications for Health Equity in Communities Hosting Historically Black Colleges and Universities (HBCUs)

Background Every year, thousands of young, black, high school graduates who are seeking higher education, attend one of the 105 historically black colleges and universities (HBCUs) located primarily in the south and east. The objective of the research was to examine the geographic proximity of HBCUs to areas of high HIV and STI disease burden among college age people to assess infectivity of potential sex partners in the areas surrounding HBCUs. Methods We examined the 14 states reporting the greatest HIV diagnoses burden among persons age 20-24 years old and STI burden among persons age 15 to 24 years old available for 2010. The Geographic Information System was used to create a spatially referenced data base of state level HIV and STI disease rates and HBCU zip codes to answer the question “How many HBCUs are in this location?” Maps were created to show HBCU locations in states along with the associated HIV and STI disease burden. Findings Results suggest high HIV and STI disease burden in the general population of persons ages 15-24 in 10 states with 4 or more Historically Black Colleges and Universities (HBCU) and an overall high rate of HIV and STI exposure in the pool of potential sex partners. Less risky behavior by minority young adults attending HBCUs could potentially translate to high risk for contracting the diseases because of high prevalence in surrounding communities. Public Health Message Public health agencies may want to consider prioritizing HBCUs for enhanced HIV and STI prevention collaborative efforts in those areas with a high burden of HIV and other STIs

HIV Testing in Women: Missed Opportunities

Objective: To investigate opportunities for early human immunodeficiency virus (HIV) testing on women. Methods: A retrospective cohort study design linked case reports from HIV surveillance to several statewide health-care databases. Medical encounters occurring before the first positive HIV test (missed opportunities) were categorized by diagnosis/procedure codes to distinguish visits that were likely to have prompted an HIV test. Women were categorized as late testers (AIDS diagnosis \u3c 12 months from first HIV test date), non-late testers (no AIDS diagnosis during study period or diagnosis of AIDS \u3e 12 months of HIV diagnosis), of reproductive age (13-44 years old), and not of reproductive age (\u3e 44 years old). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to estimate risk and its statistical significance. Results: Of 3303 HIV-infected women diagnosed during the study period, 2408 (73%) had missed opportunity visits. Late testers (39%) were more likely to be black than white (aOR 1.48, 95% CI 1.12-1.95), be older (\u3e 44 years old; aOR 7.85, 95% CI 4.49-13.7), and have \u3e 10 missed opportunity visits (aOR 2.17, 95% CI 1.62-2.91). Fifty-four percent of women \u3e 44 years old were also late testers. Women \u3e 44 years old had lower median initial CD4 counts (p 44 years old and Papanicolau smear was ranked fourth for late testers. Conclusions: Feasibility and acceptability of routine HIV testing in nontraditional health-care settings, such as mammography and Papanicolau screenings, should be explored to identify late testers and older (not of reproductive age) HIV-infected women

Missed Opportunities For Early Hiv Diagnosis In Correctional Facilities

To quantify the extent that South Carolina HIV/AIDS cases could have been diagnosed during a prior arrest we designed a retrospective population-based cohort study linking case reports from HIV/AIDS Reporting System (HARS) and the South Carolina Law Enforcement Division database. Data from individuals newly diagnosed between January 2001 and December 2005 were linked with statewide arrest records from April 1991 through November 2005. Criminal history data for this report were derived from 28 state prisons and more than 250 law enforcement agencies (jails, lockups, detention centers). Odds ratios and 95% confidence intervals were used to determine how demographic variables and arrest reasons affects receipt of HIV testing. There were 1961/4036 (48.6%) incident cases of HIV diagnosis that had at least one arrest prior to their first positive HIV test. When restricted to 1286/1961 (65.6%) individuals most likely to have been HIV-infected at the time of arrest, 592 (46%) were early testers (no AIDS within 1 year) and 694 (54%) developed AIDS more than 1 year of testing (late testers). After controlling for gender, age, race, behavioral risk and source of HIV report, the odds of being a late tester increased with age (p \u3c 0.001). Overall, 3750 separate arrests were recorded for these 1286 individuals and 491 (13%) arrests were for drug and alcohol or sex crimes. Individuals with 4 or more arrests were more likely to be late testers when compared to those with fewer than 4 arrests (adjusted odds ratio [AOR] 3.30; 95% confidence [CI] 2.28, 4.72). Correctional facilities present considerable opportunities to identify individuals with undiagnosed HIV infection. Providing correctional facilities with the infrastructure for implementation of routine HIV testing would consequently have a significant impact on the health status of the entire community. © 2009 Mary Ann Liebert, Inc