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Journal ArticleDOI

HIV: The invisible epidemic of the United States healthcare system

07 Jan 2010-Social Theory and Health (Palgrave Macmillan UK)-Vol. 8, Iss: 1, pp 83-94

TL;DR: It is argued that the HIV epidemic in the United States is considerably more widespread than is officially reported and theUnited States healthcare system provides an additional pressure that simultaneously discriminates against and ignores the very people it should be targeting most.

AbstractWe argue that the HIV epidemic in the United States is considerably more widespread than is officially reported. The occasional reports of outbreaks in cities like Washington DC, comparison with other countries in the developed world and our mathematical models, all point to the conclusion that the number of people living with HIV, but not AIDS, in the United States is more than four times larger than the current estimate. Although there are many reasons that HIV-positive individuals may not be aware of their serostatus, we argue that the United States healthcare system provides an additional pressure that simultaneously discriminates against and ignores the very people it should be targeting most.

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Journal ArticleDOI
Abstract: Objectives. —Lack of health insurance and a regular source of medical care are barriers affecting use of health services by Mexican Americans. We studied perinatal and infant health service use by Mexican-American women and non-Hispanic white women and their infants enrolled in Arizona's Medicaid program and explored characteristics associated with use of health services. Design. —A descriptive comparative study that used data collected from office records, birth certificates, and household interviews. Setting. —Participants resided in the state's most populous county and were enrolled in the Arizona Health Care Cost Containment System, a health maintenance organization—oriented Medicaid demonstration project. Subjects. —Random sample of 308 Mexican-American mother-infant dyads and 312 non-Hispanic white mother-infant dyads. The women were enrolled before the sixth month of pregnancy and for 60 days post partum; their infants were continuously enrolled throughout their first year. Outcome Measures. —Timing and number of prenatal visits and a modified Kessner Index, postpartum visits, number and purpose of office visits during the infants' first year, and immunizations received. Results. —Mexican Americans averaged fewer prenatal visits than non-Hispanic whites (8.6 vs 10.2 visits) and were less likely to have "adequate" care (41.1% vs 52.8%). Both groups of mothers are well below the 68% of women nationally who receive adequate prenatal care. Controlling for important socioeconomic status and cultural characteristics, ethnicity had a strong independent effect on the number of prenatal visits and adequacy of prenatal care. Mexican-American infants made fewer visits (8.2 vs 9.8) and completed fewer age-appropriate immunizations than non-Hispanic whites. Conclusions. —Health insurance and a regular source of care are insufficient conditions for ensuring adequate use of maternal and child health services by Mexican-American Medicaid enrollees. Factors associated with their less frequent use of these preventive health services include higher numbers of children, transportation problems, and less assistance from their support system. ( JAMA . 1994;272:297-304)

26 citations


01 Jan 2016
Abstract: ......................................................................................................................................... ii

8 citations



DissertationDOI
01 Jan 2014
TL;DR: Three biological applications showing the use of impulsive differential equations in real-world problems and the existence and uniqueness of T-periodic solutions are presented, and how stability changes when varying the immune response rate, the impulses and a certain nonlinear infection term are shown.
Abstract: Impulsive differential equations are useful for modelling certain biological events. We present three biological applications showing the use of impulsive differential equations in real-world problems. We also look at the effects of stability on a reduced two-dimensional impulsive HIV system. The first application is a system describing HIV induction-maintenance therapy, which shows how the solution to an impulsive system is used in order to find biological results (adherence, etc). A second application is an HIV system describing the interaction between T-cells, virus and drugs. Stability of the system is determined for a fixed drug level in three specific regions: low, intermediate and high drug levels. Numerical simulations show the effects of varying drug levels on the stability of a system by including an impulse. We reduce these two models to a two-dimensional impulsive model. We show analytically the existence and uniqueness of T-periodic solutions, and show how stability changes when varying the immune response rate, the impulses and a certain nonlinear infection term. The third application shows how seasonal changes can be incorporated into an impulsive differential system of Rift Valley Fever, and looks at how stability may differ when impulses are included. The analysis of impulsive differential systems is crucial in developing more realistic mathematical models for infectious diseases.

5 citations


References
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Journal ArticleDOI
Abstract: Over the last two decades, women have organized against the almost routine violence that shapes their lives. Drawing from the strength of shared experience, women have recognized that the political demands of millions speak more powerfully than the pleas of a few isolated voices. This politicization in turn has transformed the way we understand violence against women. For example, battering and rape, once seen as private (family matters) and aberrational (errant sexual aggression), are now largely recognized as part of a broad-scale system of domination that affects women as a class. This process of recognizing as social and systemic what was formerly perceived as isolated and individual has also characterized the identity politics of people of color and gays and lesbians, among others. For all these groups, identity-based politics has been a source of strength, community, and intellectual development. The embrace of identity politics, however, has been in tension with dominant conceptions of social justice. Race, gender, and other identity categories are most often treated in mainstream liberal discourse as vestiges of bias or domination-that is, as intrinsically negative frameworks in which social power works to exclude or marginalize those who are different. According to this understanding, our liberatory objective should be to empty such categories of any social significance. Yet implicit in certain strands of feminist and racial liberation movements, for example, is the view that the social power in delineating difference need not be the power of domination; it can instead be the source of political empowerment and social reconstruction. The problem with identity politics is not that it fails to transcend difference, as some critics charge, but rather the opposite- that it frequently conflates or ignores intra group differences. In the context of violence against women, this elision of difference is problematic, fundamentally because the violence that many women experience is often shaped by other dimensions of their identities, such as race and class. Moreover, ignoring differences within groups frequently contributes to tension among groups, another problem of identity politics that frustrates efforts to politicize violence against women. Feminist efforts to politicize experiences of women and antiracist efforts to politicize experiences of people of color' have frequently proceeded as though the issues and experiences they each detail occur on mutually exclusive terrains. Al-though racism and sexism readily intersect in the lives of real people, they seldom do in feminist and antiracist practices. And so, when the practices expound identity as "woman" or "person of color" as an either/or proposition, they relegate the identity of women of color to a location that resists telling. My objective here is to advance the telling of that location by exploring the race and gender dimensions of violence against women of color. Contemporary feminist and antiracist discourses have failed to consider the intersections of racism and patriarchy. Focusing on two dimensions of male violence against women-battering and rape-I consider how the experiences of women of color are frequently the product of intersecting patterns of racism and sexism, and how these experiences tend not to be represented within the discourse of either feminism or antiracism... Language: en

12,242 citations


"HIV: The invisible epidemic of the ..." refers background or result in this paper

  • ...Understanding that many of these categories overlap is critical to determining the status of the epidemic (Crenshaw, 1991)....

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  • ...…people who are poor, racialised or outside the heterosexual norm, then those satisfying more than one of these 88 r 2010 Macmillan Publishers Ltd. 1477-8211 Social Theory & Health Vol. 8, 1, 83–94 descriptions may have different outcomes than those who only fit one category (Crenshaw, 1991)....

    [...]

  • ...The results are similar for the Hispanic population (Shapiro et al, 1999), some of whom are undocumented immigrants, with little access to health care or English-only services (Crenshaw, 1991)....

    [...]

  • ...descriptions may have different outcomes than those who only fit one category (Crenshaw, 1991)....

    [...]


01 Jan 2005
Abstract: Contemporary feminist and antiracist discourses have failed to consider the intersections of racism and patriarchy. To overcome this difficulty, an original approach is suggested here: that of intersectionality. In the first part, the paper discusses structural intersectionality, the ways in which the location of women of color at the intersection of race and gender makes their real experience of domestic violence, rape, and remedial reform qualitatively different from that of white women. The focus is shifted in the second part to political intersectionality, with the analysis of how both feminist and antiracist politics have functioned in tandem to marginalize the issue of violence against women of color. Finally, the implications of the intersectional approach are addressed within the broader scope of contemporary identity politics.

11,901 citations



Journal ArticleDOI
Abstract: In many instances, instead of destabilizing the assumed categories and binaries of sexual identity, queer politics has served to reinforce simple dichotomies between heterosexual and everything “queer.” An understanding of the ways in which power informs and constitutes privileged and marginalized subjects on both sides of this dichotomy has been left unexamined. Theorists and activists alike generally agree that it was in the early 1990s that we began to see, with any regularity, the use of the term “queer.” This term would come to denote not only an emerging politics, but also a new cohort of academics working in programs primarily in the humanities centered around social and cultural criticism. Only by recognizing the link between the ideological, social, political, and economic marginalization of punks, bulldaggers, and welfare queens can we begin to develop political analyses and political strategies effective in confronting the linked yet varied sites of power in this country.

912 citations


"HIV: The invisible epidemic of the ..." refers background in this paper

  • ...…benefit in reducing the sharing of needles (Jaffe, 2004), and prison projects fought for awareness that the government was the same source of power in denying both wealthy gay men and incarcerated men’s and women’s access to drugs and conditions needed to combat HIV and AIDS (Cohen, 1997)....

    [...]

  • ...Needle exchange programs proved to have a measurable benefit in reducing the sharing of needles (Jaffe, 2004), and prison projects fought for awareness that the government was the same source of power in denying both wealthy gay men and incarcerated men’s and women’s access to drugs and conditions needed to combat HIV and AIDS (Cohen, 1997)....

    [...]

  • ...Organisations such as ACT UP formed coalitions that crossed boundaries of sexuality, race and income to challenge the dominant constructions of who deserved care (Cohen, 1997)....

    [...]

  • ...ACT UP (AIDS coalition to unleash power) formed a coalition to fight US government inaction on AIDS, including needle exchange and prison projects (Cohen, 1997)....

    [...]


Journal ArticleDOI
23 Jun 1999-JAMA
Abstract: ContextStudies of selected populations suggest that not all persons infected with human immunodeficiency virus (HIV) receive adequate care.ObjectiveTo examine variations in the care received by a national sample representative of the adult US population infected with HIV.DesignCohort study that consisted of 3 interviews from January 1996 to January 1998 conducted by the HIV Cost and Services Utilization Consortium.Patients and SettingMultistage probability sample of 2864 respondents (68% of those targeted for sampling), who represent the 231,400 persons at least 18 years old, with known HIV infection receiving medical care in the 48 contiguous United States in early 1996 in facilities other than emergency departments, the military, or prisons. The first follow-up consisted of 2466 respondents and the second had 2267 (65% of all surviving sampled subjects).Main Outcome MeasuresService utilization (<2 ambulatory visits, at least 1 emergency department visit that did not lead to hospitalization, at least 1 hospitalization) and medication utilization (receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia).ResultsInadequate HIV care was commonly reported at the time of interviews conducted from early 1996 to early 1997 but declined to varying degrees by late 1997. Twenty-three percent of patients initially and 15% of patients subsequently had emergency department visits that did not lead to hospitalization, 30% initially and 26% subsequently of those who had CD4 cell counts below 0.20,×109/L did not receive P carinii pneumonia prophylaxis, and 41% initially and 15% subsequently of those who had CD4 cell counts below 0.50×109/L did not receive antiretroviral therapy (protease inhibitor or nonnucleoside reverse transcriptase inhibitor). Inferior patterns of care were seen for many of these measures in blacks and Latinos compared with whites, the uninsured and Medicaid-insured compared with the privately insured, women compared with men, and other risk and/or exposure groups compared with men who had sex with men even after CD4 cell count adjustment. With multivariate adjustment, many differences remained statistically significant. Even by early 1998, fewer blacks, women, and uninsured and Medicaid-insured persons had started taking antiretroviral medication (CD4 cell count adjusted P values <.001 to <.005).ConclusionsAccess to care improved from 1996 to 1998 but remained suboptimal. Blacks, Latinos, women, the uninsured, and Medicaid-insured all had less desirable patterns of care. Strategies to ensure optimal care for patients with HIV requires identifying the causes of deficiency and addressing these important shortcomings in care.

739 citations