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: In Poland extreme hostility towards drug users combined with the powerful influence of a traditional Catholic church have so far impeded effective education about HIV and AIDS and anti-discrimination strategies.
Abstract: The recent increase in HIV seroprevalence in Poland, particularly among injecting drug users, has been accompanied by widespread discrimination against people affected by HIV and AIDS. As in other countries, this discrimination may be attributed to a large extent to fear and ignorance about HIV and AIDS together with pre-existing prejudices against the people who are most commonly associated with the epidemic. In Poland extreme hostility towards drug users combined with the powerful influence of a traditional Catholic church have so far impeded effective education about HIV and AIDS and anti-discrimination strategies.
33 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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...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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TL;DR: Canadian volume–outcome analyses are less likely to identify statistically significant volume-outcome associations than US studies, possibly because of the smaller size of some Canadian studies, and market-based models may exacerbate existing variations in the quality of hospital care.
Abstract: How models of health care financing and delivery affect patterns of procedure volumes, outcomes, and volume–outcome associations is not known. We compared volume–outcome studies done in Canada, which provides residents with universal, single-payer health care, with those done in the United States, to determine whether there was a difference in the likelihood of finding statistically significant volume–outcome associations. We analyzed 142 articles, most (90.1%) of which were from the United States. The articles described a total of 291 separate analyses. After adjusting for the clustering of multiple analyses in the same study, the likelihood of finding a statistically significant volume–outcome association was substantially lower in Canadian studies as compared with those from the United States (odds ratio 0.24, 95% confidence interval 0.08 to 0.74, p = 0.01). This result persisted after adjustment for the procedure/condition studied, and the number of study subjects. Canadian volume–outcome analyses are less likely to identify statistically significant volume–outcome associations than US studies, possibly because of the smaller size of some Canadian studies. It is also possible that different models of health care financing and delivery affect patterns of procedure volumes and volume–outcome associations. By promoting competition between hospitals and providers, market-based models may exacerbate existing variations in the quality of hospital care.
31 citations
"HIV: The invisible epidemic of the ..." refers background or methods in this paper
...The US system is based on a competitive model, with subscribers able to choose between different private health insurers, often with a user co-pay and linked to employment (Urbach et al, 2005)....
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...Unlike the United States, Canada has a universal heathcare system, which allows equal access for all citizens and residents, funded through provincial taxes (Urbach et al, 2005)....
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TL;DR: The capacity to monitor the national HIV epidemic has consistently improved over the last several years, and an increasing number of states report diagnosed HIV cases to the national surveillance system, allowing data from this system to better represent the national picture.
Abstract: Since the height of HIV incidence in the mid-1980s, advances in treatment have delayed progression of HIV infection. As a result, surveillance of AIDS cases alone is no longer sufficient to monitor the current status of the HIV epidemic. At the national level, new HIV diagnoses and progression of these cases to AIDS are used to describe the epidemic. The capacity to monitor the national HIV epidemic has consistently improved over the last several years. An increasing number of states report diagnosed HIV cases to the national surveillance system, allowing data from this system to better represent the national picture. Monitoring the national HIV epidemic depends on a nationwide system using standardized methods of data collection, and establishing such a comprehensive system remains one of the highest priorities for national HIV case surveillance.
28 citations
"HIV: The invisible epidemic of the ..." refers result in this paper
...…undiagnosed HIV-positive individuals and multiple diagnoses have placed the prevalence of PLWHA (people living with HIV/AIDS) at 1039 000–1185 000 (Glynn et al, 2007), in agreement with other estimates (McQuillan et al, 2006; UNAIDS, 85r 2010 Macmillan Publishers Ltd. 1477-8211 Social Theory &…...
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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
"HIV: The invisible epidemic of the ..." refers background in this paper
...Even when on treatment, African Americans have been shown to be 41–73 per cent less likely than whites to receive particular drug agents (Moore and Hepworth, 1994), even when age, sex, mode of HIV transmission, insurance, residence, income and education are excluded (Graham et al, 1994)....
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TL;DR: The paper contrasts the 'right not to know' one's HIV status which is widely respected in Britain, with the 'responsibility to find out' which is more pervasive in Hungary and Sweden.
Abstract: This paper compares policies on named HIV testing in the context of HIV prevention in Britain, Hungary and Sweden, and considers the extent to which these policies are based on evidence of effectiveness or on other, more contextual, factors. In Britain, testing has not featured significantly as a prevention strategy, and named testing has generally been carried out only with the voluntary, informed consent of individuals. In Hungary, testing is central to HIV prevention, and is required by law of certain groups. HIV testing is carried out mainly on a voluntary basis in Sweden, but, unlike in Britain, it has been actively promoted by public health authorities. The paper contrasts the 'right not to know' one's HIV status which is widely respected in Britain, with the 'responsibility to find out' which is more pervasive in Hungary and Sweden. Although policy makers in all three countries appear convinced that their's is the right approach, there appears to be as yet a dearth of convincing evidence to support their arguments.
18 citations
"HIV: The invisible epidemic of the ..." refers background in this paper
...HIV testing should be understood to be a preventive tool, rather than a diagnostic one (Danziger, 1998)....
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