Medically eligible women who do not use HAART: the importance of abuse, drug use, and race.
Journal: 2004/August - American Journal of Public Health
ISSN: 0090-0036
PUBMED: 15226135
Abstract:
OBJECTIVE
We investigated the prevalence and characteristics of HIV-positive women who do not report highly active antiretroviral therapy (HAART) use.
METHODS
We analyzed HAART use among 1165 HIV-positive participants in the Women's Interagency HIV Study.
RESULTS
Between October 1, 2000, and March 31, 2001, 254 women with clinical indications for HAART reported not using it, 635 reported HAART use, and 276 had no clinical indications. In multivariate analysis, using crack/cocaine/heroin and a history of abuse decreased the likelihood of using HAART, whereas being White increased it.
CONCLUSIONS
One of 4 women for whom HAART was indicated reported not using HAART. Childhood sexual abuse prevention, more intensive abuse treatment, and continuing drug treatment may enhance HIV disease treatment of women.
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Am J Public Health 94(7): 1147-1151

Medically Eligible Women Who Do Not Use HAART: The Importance of Abuse, Drug Use, and Race

Mardge H. Cohen is with the CORE Center, Cook County Hospital, Cook County Bureau of Health Services, Chicago, Ill. Judith A. Cook and Dennis Grey are with the Department of Psychiatry, University of Illinois, Chicago. Mary Young is with the Department of Medicine, Georgetown University Medical Center, Washington, DC. Lawrence H. Hanau is with the Department of Medicine, Montefiore Medical Center, Bronx, NY. Phyllis Tien is with the Department of Medicine, University of California, San Francisco, and San Francisco Department of Veterans Affairs. Alexandra M. Levine is with the Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles. Tracey E. Wilson is with the Department of Preventive Medicine and Community Health, SUNY Downstate Medical Center, Brooklyn, NY.
Requests for reprints should be sent to Mardge H. Cohen, MD, 2020 W Harrison, Chicago, IL 60612 (e-mail: gro.retneceroc@nehocm).
Requests for reprints should be sent to Mardge H. Cohen, MD, 2020 W Harrison, Chicago, IL 60612 (e-mail: gro.retneceroc@nehocm).
Accepted September 3, 2003.

Abstract

Objectives. We investigated the prevalence and characteristics of HIV-positive women who do not report highly active antiretroviral therapy (HAART) use.

Methods. We analyzed HAART use among 1165 HIV-positive participants in the Women’s Interagency HIV Study.

Results. Between October 1, 2000, and March 31, 2001, 254 women with clinical indications for HAART reported not using it, 635 reported HAART use, and 276 had no clinical indications. In multivariate analysis, using crack/cocaine/heroin and a history of abuse decreased the likelihood of using HAART, whereas being White increased it.

Conclusions. One of 4 women for whom HAART was indicated reported not using HAART. Childhood sexual abuse prevention, more intensive abuse treatment, and continuing drug treatment may enhance HIV disease treatment of women.

Abstract

Women are one of the fastest-growing groups infected with human immunodeficiency virus (HIV) in the United States.1 When women with HIV use highly active antiretroviral therapy (HAART), dramatic declines in morbidity and mortality have been reported.2–5 However, both patient and provider characteristics have been shown to influence HAART use in women. As we have previously shown, African American women, those with a history of injection drug use, and those currently using alcohol and illicit drugs were less likely to report initiating HAART.6 Additionally, women with high levels of depressive symptoms are less likely to use HAART, whereas those receiving mental health treatment are more likely to report use of HAART.7 Further, women receiving care from HIV specialists are more likely to receive recommended antiretroviral therapy.8

As HAART regimens become more varied and convenient, it is important to examine why women who are medically eligible for this therapy remain untreated. We report here on the prevalence and predictors of lack of HAART use in 2000–2001 among medically eligible women enrolled in the Women’s Interagency HIV Study (WIHS), a cohort study of women with and at risk for HIV infection, representative of women with HIV in the United States.9

Acknowledgments

The WIHS is funded by the National Institute of Allergy and Infectious Diseases, with supplemental funding from the National Cancer Institute, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute of Craniofacial and Dental Research. (Grants U01-AI-35004, U01-AI-31834, U01-AI-34994, U01-AI-34989, U01-HD-32632, U01-AI-34993, U01-AI-42590, M01-RR00079, and M01-RR00083).

Data in this manuscript were collected by the Women’s Interagency HIV Study Collaborative Study Group with centers (principal investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington, DC Metropolitan Consortium (Mary Young); The Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt, Phyllis C. Tien); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); Data Coordinating Center (Alvaro Muñoz, Stephen J. Gange).

Human Participant Protection
We obtained informed consent from the participants in accordance with procedures and consent materials reviewed and approved by the committee on human experimentation at each of the collaborative institutions.

Acknowledgments

Notes

Contributors
M. H. Cohen conceived the study, synthesized analyses, and led the writing. J. A. Cook and D. Grey completed the analyses. M. Young, L. H. Hanau, P. Tien, A. M. Levine, and T. E. Wilson assisted with the study and interpretation of analyses. All authors helped to conceptualize ideas, interpret findings, and review drafts of the article.

Peer Reviewed

Notes
Contributors
M. H. Cohen conceived the study, synthesized analyses, and led the writing. J. A. Cook and D. Grey completed the analyses. M. Young, L. H. Hanau, P. Tien, A. M. Levine, and T. E. Wilson assisted with the study and interpretation of analyses. All authors helped to conceptualize ideas, interpret findings, and review drafts of the article.
Peer Reviewed

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