Annotated Bib, post 10

Blair, Janet M., Jennifer L. Fagan, Emma L. Frazier, Ann Do, Heather Bradley, Eduardo E. Valverde, A. D. McNaghten, et al. “Behavioral and Clinical Characteristics of Persons Receiving Medical Care for HIV Infection — Medical Monitoring Project, United States, 2009.” MMWR Surveillance Summaries 63, no. 5 (June 20, 2014): 1–28.
 Introduction
At the end of 2009, about 864,748 persons in the U.S. (including District of Columbia and the 6 dependent areas) were living with human immunodeficiency virus (HIV). In 2005, the CDC implemented the Medical Monitoring Project (MMP) to represent data for those living with HIV.
Methods
23 areas were funded to collect data from the MMP.  Two versions of the same questionnaire were given (in English and Spanish): a standard and short version. The short questionnaire was only given if someone spoke a language other than Spanish or they were too ill for the longer interview.
Results
603 eligible facilities in the aforementioned 23 project areas yielded 461 locations that participated in MMP. 9,338 patients were sampled from the participating facilities, but only 4,217 patients had medical record abstractions and completed the standard questionnaire. The sample of 4,217 patients is used to represent the 421,186 adults with HIV who received outpatient care during January to April of 2009. The source then refers to the 421,186 as patients.
Gender
71.2% of patients were male, 27.2% were female, and 1.6% were transgender.
Sexual orientation
Surprisingly, 50.3% were self-identified as heterosexual, following 41.4% identifying as homosexual (gay or lesbian), and 8.3% were bisexual.
Race/ethnicity
41.4% of the patients were black, 34.6% were white, and 19.1% were Hispanic or Latino.
Education
50.6% of the patients had more than a high school education.
Healthcare
81.1% had health coverage, between Medicaid, private health insurance, and Medicare.
Other
9% of patients were homeless. 82.7% were born in the U.S. 43.8% of the patients’ household incomes were “at or below federal poverty guidelines.”
Depression and Substance Use
12.4% of patients had major depression, and 23.7% of patients had moderate or severe depression. Additionally, approximately 42.4% of the population smoked at the time. The estimated prevalence of alcohol use was 66.4% amongst patients. As discussed in other sources, there was a percentage of those that drank alcohol before sex: 24%.
The source indicates that depression can lead to treatment non-adherence, which can lead to death and HIV transmission risks. An HIV-infected patient with depression may also use substances, leading to risky behaviors and the probability of HIV transmission.
Sexual Behavior
47.1% of patients were men who have sex with men (MSM). 24.7% of all patients engaged in unprotected sex. About 31.8% of MSM had unprotected anal intercourse, with 13.7% having unprotected sex with a parter who’s HIV status is negative or unknown.
The source states that the prevalence of remaining risky sexual behaviors demonstrates the need to implement HIV prevention in patients’ medical care.
Met and Unmet Need for Support Services
Approximately 57.7% of patients received “HIV case management services”, but only 42% of patients received counseling on preventing the spread of HIV.
Prevention Activities
About 44.8% of patients received counseling on prevention of HIV and STDs from a healthcare provider. 54.8% of patients also received free condoms from a variety of organizations.
Those given free condoms exhibit a higher percentage of usage in condoms.
Discussion
The source states that HIV-infected persons are more likely to be homosexual black men, that are also less likely to have access to promotional healthcare.
The source urges that programs and policies relating to HIV consider the multiple needs of those with HIV, because many cannot afford health coverage. The less-than-half percentage of patients counseled on prevention reveals the missed opportunities to educate more patients.
 Final Thoughts
As discussed by numerous other sources, there is a large gap of research for LGBT service members in the U.S. military. Many sources examine the information on civilian counterparts, which gave me the idea to examine the behavioral and clinical characteristics of a civilian. This source also relates to source 9, which discusses the races and factors that may play a part in infection and/or receiving care, including access to and use of health care. It also relates to previous sources in that it discusses unmet needs for supportive service. This source, like others, considers the mental and sexual health of those infected, along with drug and alcohol use.
The source does well with admitting bias and limitations, including a face-to-face interview, which can cause social response bias. Additionally, patients in the MMP have “a usual source of HIV care and are receiving medical care.” However, the source, though putting the statistics in numerical versions, had a tendency to overestimate or underestimate certain information.

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