HIV: The invisible epidemic of the United States healthcare system
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.
Abstract: We 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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79 citations
TL;DR: In this article, the authors 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.
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
TL;DR: Wang et al. as discussed by the authors analyzed the long-term trends of HIV/AIDS incidence by gender in China and the U.S. between 1994 and 2019, and observed an oscillating trend of the age-standardized incidence rate (ASIR) in China, and an increasing ASIR trend in the U.,S. population.
Abstract: Although the human immunodeficiency virus (HIV) caused one of the worst epidemics since the late 20th century, China and the U.S. has made substantial progress in tackling its HIV and AIDS epidemic. However, the trends of HIV and AIDS incidence remain unclear in both countries. Therefore, this study aimed to highlight the long-term trends of HIV/AIDS incidence by gender in China and the U.S. population. It may helpful to assess the impact/role of designed policies in control of HIV/AIDS incidence in both countries. The data were retrieved from the Global burden of disease (GBD) database. The age-period-cohort (APC) model and join-point regression analysis were employed to estimate the age-period-cohort effect and the average annual percentage change (AAPC) on HIV incidence. Between 1994 and 2019, we observed an oscillating trend of the age-standardized incidence rate (ASIR) in China and an increasing ASIR trend in the U.S. Despite the period effect in China declined for both genders after peaked in 2004, the age effect in China grew among the young (from 15-19 to 25-29) and the old age groups (from 65-69 to 75-79). Likewise, the cohort effect increased among those born in the early (from 1924-1928 to 1934-1938) and the latest birth groups (from 1979-1983 to 2004-2009). Whereas in the U.S., the age effect declined after it peaked in the 25-29 age group. People born in recent birth groups had a higher cohort effect than those born in early groups. In both countries, females were less infected by HIV than males. Therefore, besides effective strategies and awareness essential to protect the young age groups from HIV risk factors, the Chinese government should pay attention to the elderly who lacked family support and were exposed to HIV risk factors.
11 citations
01 Jan 2016
TL;DR: In this paper, the authors propose a solution to solve the problem of the problem: this paper ] of unstructured data, which is also referred to as data augmentation.
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8 citations
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.
7 citations
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TL;DR: The concept of vulnerability is an important one for nurses because of its implications for health and trends in society indicate that increasing numbers of vulnerable people will create additional demands on an already over-burdened health care system.
Abstract: The concept of vulnerability is an important one for nurses because of its implications for health. The experience of vulnerability creates stress and anxiety which affects physiological, psychological and social functioning. Although everyone is vulnerable at different times in his or her life, some individuals are more likely to develop health problems than others. Vulnerability is affected by personal factors as well as factors within the environment. Trends in society indicate that increasing numbers of vulnerable people will create additional demands on an already over-burdened health care system. Vulnerability is an area that requires much further research and application.
201 citations
"HIV: The invisible epidemic of the ..." refers background in this paper
...…dislike of doctors/hospitals, stigmatisation of the HIV test, relationship between infection and criminal activity or fear of consequences (such as travel/ visa restrictions) for an HIV-positive result (Watney, 1989; Danziger, 1994; Rogers, 1997; Valdiserri et al, 1999)....
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...Furthermore, Canada has a commitment to preventive healthcare (Rogers, 1997), which has improved the overall health of the average Canadian (Starfield, 2000)....
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...health, dislike of doctors/hospitals, stigmatisation of the HIV test, relationship between infection and criminal activity or fear of consequences (such as travel/ visa restrictions) for an HIV-positive result (Watney, 1989; Danziger, 1994; Rogers, 1997; Valdiserri et al, 1999)....
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165 citations
"HIV: The invisible epidemic of the ..." refers background in this paper
...…messages; it has been shown that physicians who receive culturally specific training are vastly more effective in minority communities (Wade and Bernstein, 1991), whereas culturally relevant videotape messages have more impact on AIDS information in minority communities than standard…...
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01 Aug 2006
154 citations
"HIV: The invisible epidemic of the ..." refers background or methods in this paper
...In a recent publication (Aggarwala, 2006 b), we have argued that HIV prevalence in Canada should be towards the lower limit of the UNAIDS estimates, rather than the estimate of Health Canada, which is towards the middle limit (Boulos et al, 2006)....
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...The Public Health Agency of Canada has also used back-calculation methods, accounting for undiagnosed and multiply diagnosed individuals, to estimate the Canadian prevalence at 48 000–68 000 PLWHA at the end of 2005 (Boulos et al, 2006)....
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TL;DR: African-American women recruited from low-income housing projects in Chicago were randomly assigned to view a standard public health service tape on prevention of acquired immunodeficiency syndrome (AIDS), or a tape that included the same content but was framed in a context specifically intended to increase cultural relevance.
Abstract: African-American women recruited from low-income housing projects in Chicago (N = 106) were randomly assigned to view 1 of 3 20-min videotapes: a standard public health service tape on prevention of acquired immunodeficiency syndrome (AIDS), the same public health service tape but matching presenter and participant ethnicity and sex, or a tape that included the same content but was framed in a context specifically intended to increase cultural relevance. Participants who viewed the tapes presented by African-American women were significantly more sensitized to AIDS and were more likely to have discussed AIDS with friends, to be tested for human immunodeficiency virus (HIV) antibodies during the follow-up interval, and to request condoms at follow-up. These results support the use of culturally sensitive AIDS prevention messages targeted to specific populations, particularly to promote HIV-antibody testing.
145 citations
TL;DR: An epidemic of HIV infection occurs in North Carolina college students, primarily involving African American MSM and MSM/W, which deserves further HIV prevention interventions.
Abstract: Approximately 16 million people are enrolled in institutions of higher learning in the United States. However college students have not been perceived as at high risk for HIV infection. In early 2003 acute HIV infection was diagnosed in 2 men attending college in North Carolina. We describe an epidemiologic investigation of newly diagnosed HIV infection in men attending college in North Carolina. We reviewed state surveillance records examining new HIV diagnoses in men 18–30 years old between January 1 2000 and December 31 2003 living in 69 North Carolina counties. Risk behavior and demographic information for HIV-infected men enrolled in college were compared with HIV-infected male non-enrollees. Of the 735 records available for review 84 (11%) were college men. Eighty-seven percent of college men were African American and 92% were men who have sex with men (MSM) or men who have sex with men and women (MSM/W). Compared with non-college men college men were more likely to be African American (odds ratio 3.70 95% CI = 1.86–7.54) to report meeting sex partners at bars or dance clubs (odds ratio 3.01 95% CI = 1.77–5.10) or on the Internet/chat lines (odds ratio 4.95 95% CI = 2.53–9.64) or to report use of ‘‘ecstasy’’ or club drugs (odds ratio 4.51 95% CI = 1.15– 15.40). Newly diagnosed HIV infection was found in men in 37 colleges located in North Carolina or surrounding states and a sexual partner network investigation linked 21 colleges 61 students and 8 partners of students. We describe an epidemic of HIV infection occurring in North Carolina college students primarily involving African American MSM and MSM/W. College students represent an at-risk accessible population which deserves further HIV prevention interventions. (authors)
143 citations